How to Avoid 'Tech Neck' with Dr. Andrew Bang

Podcast Transcript

John Horton:

Hello, and welcome to the Health Essentials Podcast. I'm John Horton, your host. Today, we're going to talk about how smartphone use has become a real pain in the neck for many people. Peering down at that little screen takes a surprisingly big toll on our bodies. It's not one glance that does it, of course, it's the cumulative effect of dropping our gaze an average of four and a half hours per day to check texts, read the news or catch the latest social media gossip. This movement can eventually cause a repetitive stress injury dubbed tech neck. So, what can you do to block those unwanted aches and pains? To find out, we made a call the chiropractor Andrew Bang, one of the many trusted experts at Cleveland Clinic who pop into our weekly podcast to offer advice to help you live a healthier life. Let's see what he has to say.

Dr. Bang, thank you so much for joining us again. It's always a good day when I see you on the interview schedule.

Dr. Bang:

Thanks, John. Yeah, man, I love it. We've done a lot together now over the years, haven't we?

John Horton:

We definitely have. So today, we're talking about tech neck, and I have to think that the chiropractor in you, as you walk around and you see everybody on their phones, you just want to grab them and go, no, stop it! Does that happen to you a lot?

Dr. Bang:

Oh, of course. My kids probably will someday do a lot of counseling because I've just nagged them to death. hey, look up, stop it. We actually had to change my kid's gaming setup, so his neck was straight ahead on his computer. So yeah, I'm a stickler.

John Horton:

And that's why you're here. I think for a lot of us, it's hard to look at your smartphone and think that it's something that's going to cause an injury. So, what is happening? How is it hurting you?

Dr. Bang:

OK, so I can't take credit for this. So, Dr. Kenneth Hansraj, he's a neurosurgeon out of New York Spine Surgery. He did this great study evaluating stressors on the cervical spine. His real theory was like, OK, if I have to fuse a patient from a traumatic injury, what's going to happen? Does it matter if I fuse them straight up and down or slightly flexed? Is it a big deal? So, he found out some pretty cool numbers that's helped me really try to send this message home to patients. So, think of your head like a bowling ball, a 10 to 12 pounder. OK, that's a lot of weight, right? You've been bowling before, right, John?

John Horton:

Your head is really that heavy? It's 10 to 12 pounds?

Dr. Bang:

Yes, maybe for you it's 12 because you're so smart, but for the rest of us it's 10 t0 12 pounds. But essentially, as that ball moves forward, flexing or away from your shoulders, it gets heavier. So, it goes from 10 to 12 pounds, and if you go 15 degrees of flexion just like down a little bit, now it's 27 pounds.

John Horton:

Wow.

Dr. Bang:

Yeah. More than double, right? That's like crazy quick up in weight. But that's not even like when you're looking down your phone. You're doing way more than 15 degrees of flexion. You're doing more like 30, probably. And when it's 30 degrees forward, now it's 40 pounds of stress on your neck and those joints, and it just keeps climbing. When you're looking down in your lap, which is about 60 degrees, now it's 60 pounds of pressure on your neck and shoulders. It's crazy. For some people, that's half their body weight or a third of their body weight.

John Horton:

It's mind-blowing. You're throwing more info in there. Now my head's getting even heavier!

Dr. Bang:

So yeah, the next time you go bowling, you listeners, take that bowling ball and just see how much harder it is the further away you hold that ball from your body, how much heavier it is perceived, and that's what's happening in your neck and shoulders. So, you look down for a second or two at something, no big deal. But now you do that over a sustained period of time when you're watching this really good TikTok or you're watching something on YouTube or reading a long email, then, that's where the real problem comes into play. That's when the injuries start happening in your neck and all the muscles around there.

John Horton:

Where is it hurting? Is it just your neck, shoulders? How far down does it go? I mean, where is all that force?

Dr. Bang:

The force, literally, we see this clinically, in those lower cervical vertebrae. So, we have seven cervical vertebrae. And they find that the most, the area, it's C5 and 6, and then the next most common area is C6 and 7. Between those segments, there's a jelly disc between all of them, but those ones are the ones we see most commonly disintegrating or degenerating in the cervical spine because of that forward head posture. Truly, you can see that. And I think that the problem is when you're doing the action of looking down, that's not when you feel the pain. In fact, you're usually so engrossed in what you're looking at that you don't even feel the symptoms of tech neck until later on. And unfortunately, it's kind of like a cumulative effect.

So, it's like, you spend a few minutes looking down, it's no big deal. Now you do that throughout the day, and by the end of the day, where you've spent anywhere from three to four hours on your tablet, phone, computer, you name it, any technology where your head goes forward, now we got problems. You got stiffness, tightness, pain, and then that, in turn, leads to these chronic conditions of arthritis in the neck. That's where you have extra bone growing into the joint, which we call osteophytes. You've got degeneration of those jelly discs inside. You've got overstretching of the muscles and tendons causing tendonitis. It's like a tsunami that you didn't see coming, unfortunately.

John Horton:

Oh, man. What does tech neck feel like? Because like you said, it's not something where, like, you stub your toe, you instantly know you hurt yourself. I mean, tech neck's something that's going to come later, but what are the signs where you might say, I got to start watching what I'm doing?

Dr. Bang:

Oh, I like that. So first of all, if you really to get in the moment, you can feel it right now. So, I'm not going to walk you through this. Well, yes. OK, let's do this, John.

John Horton:

Walk us through it.

Dr. Bang:

John, here’s what you need to do. I need you to pretend that you're reading this really great text message. So, look down, literally in your lap. Let's pretend you're at work, and you're reading a funny YouTube thing that you're not supposed to be doing, so you're trying to hide it.

John Horton:

You know me too well.

Dr. Bang:

So, you're looking in your lap and the weight of your head is now we said about 60 pounds. And you can feel, do you feel tension in those muscles?

John Horton:

You can, right here in the back of your neck, kind of like right where it's coming into your shoulders. You can feel the stress and a little pulling.

Dr. Bang:

And so, for some of us, it will extend all the way down even to your mid-back where you can start to feel that pull. Because all those muscles, the trapezius, the splenius capitis, all those ones that anchor your head and keep it upright, they're getting tugged. And depending on the person, it's all about your muscle endurance. So, if you have a lot of endurance in those muscles, you could be there for a while before you notice the pain. And some people have neck injuries or bad muscle tone there for whatever reason. They're going to feel it a lot quicker. So, helping people be aware if they're in that position and just say, hey, what am I feeling? They'll feel instantly, tension, pain or whatever.

But for most of us who don't, this is what you really need to look out for. When you're like, my neck hurts and I have no idea why. You just cannot figure it out. And you're like, maybe I sleep funny. Did I trip and fall? Did I lift something heavy? And you just can't seem to correlate an action with what's going on. And/or the second thing that you really want to see is, on the weekend I feel better, or on my day off, I feel better. I started noticing this when patients would come in and just tell me those exact things. I have no idea what I did, or I feel better on the weekends. And I started realizing, well, it's all statistical. Where you spend your time is where you're putting your stress. So that's the first things I go to. What do you spend your most time doing, John? You, during the day. What do you do most of your day?

John Horton:

Looking at a computer screen or my phone, yeah.

Dr. Bang:

And then the second thing, or third thing, if it's computer, then phone, for the third thing, for someone, is the car. And they may have really bad forward head posture in the car. And the next thing most people do, spend the most time at, is sleeping. And so yeah, we talk about neck, but the ideas go to where you spend most of your time, and that's typically when you don't know what you did, that's the answer. So that's why I try to tell people, if you have neck pain or neck or shoulder tightness or mid-back pain, what do you spend most of your day doing? And that's what we need to evaluate.

John Horton:

Well, you were talking about finding answers, which brings us to the next thing, which is what would you recommend doing to treat tech neck if you are starting to feel these symptoms or getting those aches?

Dr. Bang:

So yeah, of course, you have the options of physical therapy, chiropractic, your primary care doctor. Those are great. But yeah, let's say you want to start, you make your appointments two or three weeks out before you can really get in to be seen or even a couple days. Start now. You can start this very second right now, doing some things to feel better. And we mentioned this in another podcast, and you and I always joke about this quote, motion is lotion. That's huge. Your body loves motion, and your body loves variety of motion. So, when someone, we're identifying that they're hurting because they're at their cell phone or computer, we got to change that either by moving them and or creating variety. So, if you have a standing sitting desk, you got to use that more often. You're probably not using it enough because when you sit and stand, now you're allowing your body to move because you're going from a down position to an up position.

If you have a cell phone, we're talking about changing positions where it's down in my lap to where you're putting it up in front of your face. So, your head is looking straightforward. And then, what I will typically do, so now, I don't turn into having shoulder problems by holding my phone up, I tend to rest my arm on my belly and then rest the arm that's holding my phone and my elbow on that arm so that I'm not doing a lot of work except for things are resting on each other, but my phone is now straight in front of my head.

John Horton:

That makes a lot of sense, to keep it out there and to make sure your head is always aiming straight, so you only have that 10-to-12-pound weight going.

Dr. Bang:

But again, even if you have the best posture, people often ask me, hey, what's the best posture you can have? That doesn't exist. The best posture is a moving posture. So yes, you can get your body in ideal postures, like when you're sitting at your computer having the screen really high. In fact, the recommendation is if you could chop your screen into three segments, and I'm saying three segments like three horizontal segments, if you were looking at the top third, the bottom portion of the top third is where ergonomics people, specialists, recommend our eyes should rest because that's kind of where we get the least amount of stress on our neck from that. So, you get your computer screen set and you do that. If you don't move, doesn't matter if you're at perfect posture at your desk, you're going to have pain.

So, we're talking about, yes, set your screen up, set your tablets up, set your cell phone up. When you're driving in the car, I will often have people kind of keep their head tapped, resting slightly against the headrest so their head is over their shoulders. But you got to move a little better or you're going to have just as much issue with perfect posture, quote, unquote perfect posture.

John Horton:

Definitely. And another thing I know, and we've talked about this through our many discussions, is giving yourself breaks. I mean, do you have to just put that phone down every once in a while? Do you advise that?

Dr. Bang:

Yeah. So yes, I talk about being realistic. Change what you can change and then what you can't change, don't worry about, essentially. If you have to use your phone for work, then you just got to be creative, bringing the arm up, use your right arm for 30 minutes, 20 minutes with it resting.

John Horton:

Cross-training.

Dr. Bang:

Yes. Switch it to your left. Cross-training, exactly. Then, maybe do an email talk to text instead of sitting there typing it out. So then, you talk out most of your email. Then, when you go to edit it, you're only typing a few words where it thought you said one thing and it wrote a different one. Right?

John Horton:

Happens all the time. Yeah.

Dr. Bang:

Put your phone on speaker instead of crimping your phone always to the one side. Use headphones so that you're listening and instead of always having your phone on your right side of your body, creating that tension and issues, now it's in front of you because you're using headphones or the speaker. I know this stuff sounds really elementary.

So, we teach this pain class at the clinic here where we have about 10 students come in, and we do six weeks where there's different topics. And I'm one of those weeks. And we come in and these people have chronic pain typically, and we evaluate these different functions of their life, sleep, cell phone use, car use, et cetera. And it is amazing to me. People have these light bulb moments where they're like, what? It's literally that simple? And it literally is, but it's just being self-aware of what the heck am I doing and what can I change simply and still be effective? Because again, I can't be like, John, yes, take a break from your computer. I'm sure your work's going to love that.

John Horton:

No, I'll try. I was hoping for a doctor's note saying I need to take an hour or two off every day, but that's not going to happen.

Dr. Bang:

People have asked me for those, and unfortunately, I can't do that. But what I can do is tell them how to have motion and how to have variety. And if you can sneak those two things into your life in every situation, you can self-evaluate the best thing here. Because I can't follow you around as much as I'd like to, I know that doesn't sound creepy or nothing, but follow you around and say, John, don't do that. John, do this. Just self-evaluate. am I moving? Have I been stuck here for a while? And are my movements variety filled? Are they different? Or am I getting into this repetitive strain where I'm having injury?

John Horton:

Whenever we chat, Dr. Bang, I'm always amazed at how we have these complicated issues as far as these aches and these pains and the solutions always seem just so simple, especially the way you explain them. So, anything else you want to add in, or what else should people, if they really want to take something away from this discussion, what would it be?

Dr. Bang:

I would say that there's a really simple way to create variety in muscles when you're having pain. Because a lot of this, now, we didn't really talk about like, OK, let's say you have tech neck, we said you could create variety in motion, but I didn't really give some good examples of how to do that. So, let's do that, John.

John Horton:

Let's do it.

Dr. Bang:

So, let's talk about some examples of things you can actually do right now besides motion is lotion and variety. Because those are just blanket statements. What does that actually mean? So, all right, if it's tight, we want to stretch it. If it's loose, we want to tighten it. And what that means is you have some muscles when we sit, use our computer, use our phone, and they get overly tight and some get overly stretched. So as a rule of thumb, the sides and front neck muscles will get overly tight. So, we want to stretch those. And there's a very simple way to do that. You hold the side of your chair. Do it with me, John. Reach down there.

John Horton:

I am. I'm there.

Dr. Bang:

Then, you're going to lean opposite to the side of the chair you're holding it, with your head looking straightforward.

John Horton:

Yeah. Wow.

Dr. Bang:

And then, to make this even better, we want to look slightly up towards the ceiling and you're going to feel it kind of in the front of your neck.

John Horton:

I need to stretch more, Dr. Bang.

Dr. Bang:

Everyone does. It's amazing. I know. This feels so good, doesn't it? All right. So yeah, sides and front are tight usually, on most of us, because our head is forward. We call this an upper cross syndrome. So, our head is too tight, too forward. The back muscles usually get overstretched. So, we've stretched. And oh, as a rule of thumb, your stretches need to be way longer than you think they do. There's a study out there that talks about two minutes per muscle group. Yeah, I know, it's crazy. That seems forever.

John Horton:

Yeah. I'm happy if I hit 30 seconds. Two minutes?

Dr. Bang:

I know. Most people do like five and they're done. So yeah, try to get to that 30-, 45-second mark. Work towards the two minutes. But you'll want to stretch the tight ones. And then, the weak ones, the overstretched, like those neck muscles in the back, if we stretch forward down, you're already overstretching something that's too stretched. So, we want to tighten it. We'll do an isometric. So, with my head in perfect posture, take my hands behind me, interlace my fingers, and now I'm going to push back, and I'm going to push back with quite a bit of force.

John Horton:

Push back with your head in your hands?

Dr. Bang:

Yes. Push back my head, push forward with my hands. You feel those muscles really tighten up, right?

John Horton:

Yeah.

Dr. Bang:

So, this is how you create variety and this is how you create motion without moving much, right, when you're stuck reading. You can do this while you're reading an email. You can do this while you're on a conference call.

John Horton:

You can do this in a meeting.

Dr. Bang:

Exactly.

John Horton:

It looks like I'm contemplating something.

Dr. Bang:

That's right.

John Horton:

So, you want to push hard enough. We're talking like 60 percent, 80 percent of your max muscle contraction capability to get the blood cranking through there, wake up that sleepy muscle, tighten it back up where it got you loose. I mean, the other ones that get really tighter are your pecs. So, I'll hold the side of my desk and I'll turn and stretch. You'll feel this stretching here really good.

John Horton:

All right.

Dr. Bang:

There you go. Feel it?

John Horton:

Yep. Yeah. Oh yeah.

Dr. Bang:

OK. That one's huge. And then the other one I really find is the big one is the muscles between your shoulder blades. In fact, I don't know if you've ever experienced this, but some of your listeners will. It's mostly on your right side, some people it's left, but primarily right side, right between your shoulder blade and your spine. People say, I get this weird sensation. Sometimes, it's numb and tingling. Sometimes, it's like a burning pain or just an ache. That's that muscle being overstretched because you're reaching your arm out using your mouse all day. You're doing these micro movements.

So, what we do is we'd want to do a contraction stretch on our shoulder blade muscles. So, pretend like you're trying to pinch a pencil between your shoulder blades. And then you really want to squeeze hard almost to where you feel like your muscles are going to cramp, and you kind of ride that cramp, like I like to call it. Don't let it cramp, but keep pushing hard enough like it's going to.

John Horton:

Wow.

Dr. Bang:

Same thing. You want to work towards that 30-second mark. 60-second mark is better of these contractions. So again, you want to stretch what is tight, tighten what is overstretched or loose.

John Horton:

Dr. Bang, I'm going to do all of this in my next teams meeting.

Dr. Bang:

Nice.

John Horton:

And I'll share your wisdom.

Dr. Bang:

Thanks.

John Horton:

Hey, thank you very much for joining us today. It's always great having you on the show. I can't wait to have you back.

Dr. Bang:

Thank you so much, John, take it easy.

John Horton:

The big lesson to take away from today's podcast: Pay attention to how you're looking at your smartphone and how much time you're spending on it. If you don't, you may be using that phone to call Dr. Bang for an appointment. Till next time, be well.

Speaker 3:

Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts, or visit Cleveland clinic.org/hepodcast. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.