Text neck: what looking down at your phone does, and what it doesn't

Stand on the platform at Kokura on a weekday morning and count the bowed heads. I tried it once while waiting for a late train and gave up somewhere past forty. Nearly everyone was looking at a phone, and nearly everyone was holding it the same way: down by the belt, chin dropped towards the chest, shoulders rolled forward, as if the whole platform had been asked to read its own palms.

That posture has picked up a name, text neck, and in Japan you will also hear sumaho-kubi (smartphone neck). It has picked up a reputation too. Depending on what you read, it is either quietly bending a generation out of shape or a fuss about nothing. Having spent years with my thumbs in other people's necks before I moved to Kitakyushu, I think the truth sits somewhere in between, and the useful part is less dramatic than the headlines.

The lever in your neck

An adult head weighs roughly what a 5 kilogram bag of rice weighs. When you stand or sit tall, most of that weight sits more or less over the top of the spine, and the muscles at the back of the neck only need to tick over to keep it balanced.

Tip your head forward and the weight moves out in front of the point it pivots on. Now those muscles have to hold it back. Think of carrying a bag of shopping. Held against your side, it is easy. Held out at arm's length, your shoulder starts to burn within a minute, even though the bag weighs exactly the same. The bag has not got heavier. The lever has got longer.

The further your head drops, the longer that lever, and the harder the muscles at the back of the neck and between the shoulder blades work. They are the same muscles behind katakori (stiff shoulders), covered in more detail in why stiff shoulders are Japan's signature complaint.

None of this is dangerous in itself. Your neck is designed to bend, and people have looked down to read, sew and chop onions for a very long time without their heads falling off. Muscles cope well with work and badly with holding one position without a break. So the real question is not the angle. It is how long you stay there.

Five claims you have probably seen

"Looking down multiplies the weight of your head"

You may have seen a drawing of a little figure with its head tipped at different angles and a weight in kilograms beside each one, climbing steeply as the head goes down. The principle is fair: more bend, more work for the neck muscles. The precise figures, though, came from a simplified model rather than from measuring living necks, and they have been passed around far more confidently than they deserve.

My verdict: right idea, shaky numbers. Treat the drawing as a picture of the lever, not as facts about your neck.

"Phones are causing an epidemic of neck pain"

Neck pain is very common, and it was common long before anyone carried a phone. When researchers have looked for a direct link between how far people bend their necks while using a phone and whether they have neck pain, several studies, mostly in young adults, have not found one. Some have found a link with the total number of hours spent on a phone each day, which fits the idea that time matters more than angle.

Nearly all of this research is a snapshot of a group of people at one moment, which can show that two things turn up together but not which causes which. People with sore necks might well spend more evenings on the sofa scrolling.

My verdict: a possible contributor for some people, not proven, and the hours probably count for more than the posture.

"Young people are growing horns on their skulls"

A story went round some years back about bony lumps at the back of the skull in young adults, blamed on looking down at phones. It made excellent headlines. The study behind it did not measure anyone's phone use, and other researchers criticised it heavily.

My verdict: do not lose sleep over it.

"You should always hold your phone at eye level"

Raising the phone helps, and I will come to how. But try holding a phone up at eye level for half an hour and see how your shoulders feel. You have swapped a tired neck for tired arms. The aim is higher than it is now, and changed often, not a perfect position you can only keep up for two minutes.

My verdict: good direction, unworkable as a rule.

"Chin tucks will fix it"

Chin tucks are a decent exercise, and they are in the list below. They are not a cure for anything on their own. For neck pain that keeps coming back, reviews of the research give the most support to regular exercise in general, especially strengthening the shoulders and upper back, rather than any one special move. Even that evidence is moderate rather than strong, and most of it comes from office workers rather than phone users.

My verdict: useful, modest, one piece of a larger habit.

Phone habits for the commute

Commutes are where the hours quietly pile up. Twenty-five minutes each way on a local train comes to over four hours a week of looking down, before you count the evening scroll. These are the changes that make the biggest difference for the least effort.

• Sitting down, put your bag on your lap and rest the elbow of your phone hand on it. The phone comes up several centimetres without any effort, and your head follows it.
• Standing, tuck your upper arm against your ribs and support that elbow with your other hand, arm folded across your body. You will look deep in thought, which on a Monday you may well be. On a moving train with no seat, keep a hand for the strap or rail. A sore neck beats a fall.
• Make the text bigger. Small type makes you lean in, and leaning in drops the head. Most phones let you raise the font size in a couple of taps.
• Use the doors as a reminder. Every time they open at a station, look up, look out of the window at something far away, and let your shoulders drop.
• Swap hands at each stop. Holding and scrolling with one thumb loads one side of the neck and shoulder more than the other.
• Some days, listen instead of reading. A podcast or an audiobook leaves your head free to sit where it likes and your eyes free to look at the sea, if your line has a view of it.

One habit to drop altogether: walking while looking at your phone. There is a word for it here, aruki-sumaho (literally "walking smartphone"), and station posters across Japan ask people to stop. Your neck is the least of it. Station stairs and platform edges are unforgiving, so step aside, stop, then look.

At home

Evening phone use is often harder on the neck than the commute, because the sofa and the bed let you sink into positions you would never hold on a train. Lying on your side with your head craned up to see the screen, or slumped against the arm of the sofa with your chin on your chest, are the classic two.

Bring the phone up rather than taking your head down. Rest your forearms on a cushion on your lap, or sit back with your elbows on the arms of a chair. For long videos or video calls, prop the phone against a stack of books at roughly eye level and let your hands rest. For longer reading or work, move to a properly set-up table; the principles in desk posture without the gadgets apply.

Four moves for a phone-weary neck

Do these slowly, a couple of times a day, on the platform if nobody is looking (or even if they are). You should feel mild effort or a gentle stretch, not pain. Stop if anything causes tingling or pain down an arm, or makes you dizzy.

1. Chin tucks. Look straight ahead and slide your chin straight back, as if making a double chin. Hold for 3 to 5 seconds and release. Repeat 5 to 10 times.
2. Look up and back. Slowly lift your gaze towards the ceiling as far as is comfortable, then bring your head back to level. Five times. This is the opposite of the position you spend hours in, done gently, not cranked.
3. Shoulder blade squeeze. Sitting or standing tall, draw your shoulder blades back and slightly down, as if trying to tuck them into your back pockets. Hold for 5 seconds. Ten times.
4. Upper back arch. Sit in a chair whose backrest reaches about the middle of your back. Support your head with your fingers laced behind it, and lean back gently over the top of the backrest until you feel your upper back open. Hold for a breath and come back up. Five times.

If neck ache keeps returning, add some strengthening two or three times a week: slow rows with a resistance band looped round a door handle, or with two full water bottles. That is where the better evidence sits.

When it is not just your phone

Most phone-related neck ache is tired muscle, and it eases within days or a couple of weeks once the habits change. See a doctor or a physiotherapist (in Japan, an orthopaedic clinic is the usual first stop) if:

• the ache has not improved after a few weeks of changes, or keeps getting worse
• pain spreads into an arm, especially with numbness, pins and needles or weakness in the arm or hand
• your hands feel clumsy (fumbling buttons or chopsticks, dropping things) or you feel unsteady on your feet, which can be signs of pressure on the spinal cord in the neck and should be checked promptly
• you get headaches that are new, severe or different from your usual ones

Some signs need help the same day, or an ambulance (119 in Japan):

• neck pain with a fever, especially with a stiff neck, a bad headache, a rash or feeling very unwell
• neck pain after a fall, a car accident or a blow to the head
• pain in the neck, jaw, shoulder or arm together with chest pain or pressure, breathlessness, sweating or nausea, which can be the heart rather than the neck
• loss of bladder or bowel control
• pain that wakes you at night and does not ease with a change of position, particularly with unexplained weight loss

The NHS website lists much the same warning signs if you want a second plain-English source.

Children and teenagers get stiff necks from phones and games too, and the same habits apply. A child whose neck pain lasts more than a couple of weeks, or comes with a fever, a headache or any of the signs above, should see a doctor.

Tomorrow morning on the train

• Bag on your lap, elbow on the bag.
• Text size up a notch.
• Look up every time the doors open.
• Swap hands at every stop.
• Five chin tucks before you get off.

Other pieces on neck, back and shoulder care are collected in posture and body care.