July 1, 2019

What has been a concern of mine since the beginning of the smart phone era may be coming true. In the past, we have focused on myopia/nearsightedness caused by the continual viewing of a device or a book close up (AOA link). That has been coming to fruition unfortunately for the past decade.

Now we see a report from Dr. Shahar and colleague regarding potential neck damage from the chronic user's downward gaze on a tablet or smart phone. Published in Nature Scientific Reports in 2018, the authors have noted an increase in "exostosis" developing on the base of studied patient's skulls.

From the article, "Recently we reported the development of prominent exostosis on young adult's skulls (41%, 10-31mm) emanating from the external occipital protuberance. These findings contrast existing reports that large enthesophytes are not seen in young adults. Here we show that a combination sex, the degree of forward head protraction and age predicted the presence of an enlarged external occipital protuberance."

"The larger distribution of EEOP in the male population may also be explained by research suggesting that males are more likely to use handheld technology devices for time-consuming gaming and movie viewing, while females are more likely to engage in short duration social activities."

What the authors are suggesting is that the persistent downward gaze has increased the traction of the posterior neck muscles on the tendons attached to the base of the skull. While this hypothesis is plausible as humans have evolved skeletally based on changing mechanical behaviors over thousands of years, it is by no means a known cause and effect. Further research will need to be performed to prove causation and not just association. However, in my precautionary belief system, I am willing to go out on a limb and state that it is not beneficial to keep your head flexed for prolonged periods of time. How problematic this behavior is remains to be seen.

My thoughts on this topic are simple,

1) Excessive screen time is not useful and likely detrimental
2) Any chronic unopposed musculoskeletal behavior has a tendency to cause dysfunction. We need equal and opposite activity to maintain balance
3) I am always a prevention first person and this seems like a logical place to prevent an issue even before we have true proof
4) Limit the amount of screen time for yourself and your family members. No screen time for children under 2-3 years of age.
5) Stretch your neck daily and especially if you notice any tense feelings
6) Make sure to encourage your children to look of into the distance often, extend their neck backward and side to side and also be aware of their neck position


Dr. M

Shahar Nature Scientific Reports Article
American Optometric Association Article