Tech neck before and after: treating forward head posture

An old pattern with a new name that is a continuously growing trend, tech neck before and after this treatment…

For many years it has been accepted as fact that low-back pain was the primary reason people sought care from chiropractors. While that may still be true, it seems that we have seen a shift toward more complaints of neck and upper back pain with the near-continuous use of personal electronic devices, resulting in some stunning visuals for tech neck before and after treatments on patients.

Tech neck is the term used to describe the position of looking downward at a cell phone, tablet or computer repetitiously and the resulting symptoms that can occur. While it seems like a new malady caused by the excessive use of technology, it’s actually an old familiar pattern that has many common contributing factors.

Contributing factors

Cell phones, tablets, laptops and even smart watches are now ubiquitous in our society, and the average age of the tech user continues to decline.

More than 25% of children receive their first cell phone between the ages of 11-12.1 Children are being issued laptop computers and tablets in elementary school, often before they have even learned to read. The vast majority of Americans — 97% — now own a “non-smart” cellphone of some kind. The share of Americans who own a smartphone is now 85%, up from just 35% in the Pew Research Center’s first survey of smartphone ownership conducted in 2011.

Tech neck is really just a new name for an old problem that is now much more common and is affecting a larger and younger portion of the population. Upper back and neck pain is nothing new for people who have spent their career sitting at a desk for hours on end in basically the same position. The posture we practice the most is the posture we present.

Virtual learning for all school-age children that was implemented in response to the ongoing pandemic has exposed many of them to an inadequate learning environment that often includes studying and attending class sitting on a bed or the floor. These positions have resulted in an increase in headache, neck and back pain complaints in younger patients.

Tech neck before and after: breaking the pattern

There is a saying in the neurology world: “What fires together, wires together.” This phrase was coined in 1949 by Donald Hebb, a Canadian neuropsychologist known for his work in the field of associative learning.

Hebb’s axiom reminds us that every experience, thought, feeling and physical sensation triggers thousands of neurons, which form a neural network. As patients learn with tech neck before and after visuals, when you repeat an experience over and over, the brain learns to trigger the same neurons each time. That’s how posture is developed, and that is the idea we must employ in the treatment of our patients.

We must help the patient create new neural networks that fire the appropriate muscles at the right time. The basic principle I use in practice is:

1) Find the pattern that the patient is stuck in;

2) Interrupt that pattern with appropriate interventions, and;

3) Help the patient make new posture and movement patterns.

The role of foot function in posture

Posture begins in the feet, and if left unchecked, a significant contributing factor to postural and biomechanical stress will continue to influence the development of neural networks that could result in dysfunctional patterns, pain and degenerative changes, not to mention altered balance and neuromuscular coordination.

I personally have been evaluating the feet of my patients for more than 30 years and have found them to be a consistent source of biomechanical asymmetry. This creates a very predictable posture pattern that involves the knees, hips, pelvis and spine, muscle imbalances and myofascial restrictions. This pattern includes anterior head carriage, which we now call tech neck, and patients are very motivated to eliminate the dreaded “hump” that is associated with it, especially when presented with tech neck before and after visuals.

Quantifying foot involvement can be easily accomplished by scanning the foot using digital 3D laser technology. This identifies differences in the three arches of the feet that can be addressed with custom stabilizing orthotics, which create a symmetrical platform that supports the medial longitudinal, lateral longitudinal and transverse arches, and stimulates a proprioceptive neuromuscular response that is the foundation of reestablishing more efficient posture.

Arch differences and treatment protocols

Arch differences can also be measured using the Navicular Drop Test. This oldie-but-goodie test involves having a patient seated and physically placing a mark on the navicular bone, then transferring the mark to a Posture Stability Index card in a non-weight-bearing seated position, and then placing a mark on the card with the patient in a standing, weight-bearing position. This allows us to quantify the amount of navicular drop and identity the difference between the right and left foot. This is a very effective way to see if the patient’s feet are part of the tech neck pattern if scanning the feet isn’t an option.

When considering treatment protocols for tech neck patients, I believe a multifaceted approach is necessary to address the multiple systems involved. Remember that as powerful as a chiropractic adjustment is, its effectiveness can be diminished by biomechanical imbalances, myofascial restriction and the long-standing neural networks that have been established in the patient.

Elements of a tech neck treatment plan

Starting with custom stabilizing orthotics sets the stage to create better posture by creating new neuromuscular patterns. Remember that what fires together, wires together.

If we have nociceptive input into the nervous system from joint dysfunction in the feet, knees, hips, pelvis, spine and upper extremities, postural reflexes will be inhibited, and adjustments will have little long-term impact on improving those patterns. The patient will feel better, but over time, function will degrade to a point that symptoms return.

Create a treatment plan with enough frequency in the early part of care to adjust the patient, release myofascial restrictions, and provide rehabilitative exercises with the goal of creating new neural networks that engage the optimal postural responses. As I said earlier, when you repeat an experience over and over, the brain learns to trigger the same neurons each time. That’s how posture is developed, and that is the idea we can employ in the treatment of our patients.

We must help the patient create new neural networks that fire the appropriate muscles at the right time. That can be accomplished with a combination of conscious efforts that include performing exercises specific to the postural distortion, learning to hold electronic devices in front of the face as opposed to looking down, and taking regular breaks from using electronic devices.

Subconsciously, these new patterns can be positively influenced with the autonomic effects of the adjustment, which is enhanced by the proprioceptive input caused using custom stabilizing orthotics. With repetition of the neurological input being so important to the development of new neural networks, the orthotics are responsible for this positive input every time the patient takes a step.

Even though tech neck is a new term for an old problem, people are more aware of the negative effects of electronic device use and are motivated to seek solutions to the pain and poor posture that results from its use. Chiropractors are in a great position to be that solution.

BRIAN JENSEN, DC, is a graduate of Palmer Chiropractic College and owner of Cave Spring Chiropractic in Roanoke, Va. He has been in practice for over 31 years. As a member of the Foot Levelers Speakers Bureau, he travels the country sharing his knowledge and insights. See continuing education seminars from him and other Foot Levelers Speakers at




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