IHunch


iHunch is the common spinal problem of an excessively kyphotic thoracic spine driving neck pain and cervicogenic headache. It is clinically recognized as a form of repetitive strain injury. The term text neck was first coined by Dr. Dean L. Fishman, a US chiropractor.
Much bending forward has always caused the problems of a hunched upper back and neck pain, for example in dentists, surgeons, and hairdressers. What has changed in the last decade is the amount, especially in a younger generation who have grown up bending over laptops, tablets and smartphones – hence the term 'iHunch'. Because the problem arises specifically from much bending forward, logical treatment will counter each component of this.

Overview

Indications are that the prevalence of upper back and neck pain has increased dramatically in the decade leading up to 2016. This increase has been attributed to the corresponding widespread adoption of laptop computers, tablets, smartphones and other small portable digital devices.
Because their screens do not separate from their keyboards these small devices cannot be set up ergonomically correctly. They are unlike personal desk top computers in this respect. Most commonly, the user hunches to operate them, often for many hours a day.
Hunching increases the effective load on the neck up to several times more than does erect posture, due to increasing moment arm. Local pain, cervicogenic headache and referred pain extending down the arms can arise from the sustained muscle strain, cervical facet joint compression and diminution of the cervical foraminal nerve exits.
A hunched posture also sends out a body language message of submission and lower self-confidence, with some research indicating it can actually promote these in the person holding it. A comprehensive view of the research and concepts is found in Amy Cuddy's book Presence.
Treatment may include analgesic and/or anti-inflammatory medications, regular breaks while using the small devices, muscle strengthening and stretching, massage, spinal manipulation and mobilisation, posture instruction and spinal fulcrums. Biomechanical analysis suggests a combination of approaches is best and gives more lasting results.

Signs and symptoms

In a neck with perfect posture the head is balanced above the shoulders. In this position the load on each vertebra of the cervical spine is spread evenly between the two facet joints at the back and the intervertebral disc and vertebral body at the front.
The iHunch is characterised by a posture with vagi at the head sitting somewhat forward of the shoulders. This can be very marked, with the back of the skull positioned anterior to the breastbone. The chin is poked forward.
When the patient is asked to look up at the ceiling, the hunched-forward upper thoracic curve does not change as viewed from the side. Rather, the lower cervical spine 'hinges' backward at C5/6/7, a movement pattern known as 'swan-necking'.
This indicates that the upper back vertebrae have frozen in their habitual flexed positions, with the surrounding collagen of the ligaments, joint capsules and fascia shortening to reinforce this hypomobility.
Symptoms include overuse muscle pain and fatigue along the back of the neck and reaching down to the mid-back, often starting with the upper trapezius muscle bellies between the shoulders and neck. Cervicogenic headache from the joints and muscle attachments at the top of the neck is common.
The compressive load on the cervical facet joints predisposes to acute joint locking episodes, with pain and movement loss. In older patients with already diminished cervical foramina spaces and/or osteophytes, nerve root irritation and impingement can trigger referred pain down the arm.

Causes

The human spine is well suited to erect upright posture, with the increased heart rate from movement shunting a good blood supply to the muscles. This is clearly not the
case for vast numbers of sedentary humans spending many hours daily bent over laptops, tablets, smartphones and similar. A biomechanical assessment of thoracic hunching shows the abnormal spinal loading and other effects which plausibly account for the recent steep rise in thoracic and cervical pain in step with the ubiquitous adoption of the small IT devices.
The gravity of stress on the spine dramatically increases with thoracic hunching, roughly 10 pounds of weight are added to the cervical spine in weight for every inch of forward head posture by looking down at a small IT device. As a consequence there is growing medical concern specifically with children as their head size is larger in relation to their body and thus pose an increased risk group for being affected by musculoskeletal and neurological issues in the neck caused by thoracic hunching.
Hunching has always caused problems, for instance in occupational groups like dentists, surgeons, hairdressers, nurses, chefs, teachers, computer workers and students. Some rheumatoid conditions like ankylosing spondylitis, neurodegenerative conditions like Parkinson's Disease, and connective tissue disorders like Ehlers-Danlos Syndrome cause characteristic excessive thoracic kyphosis. What has changed is the amount of hunching in society generally, and especially with the technologically adept young.

Epidemiology

The first laptop was produced in 1981 but it took more than a decade of development for the designs to approach current levels of portability and capacity, and hence uptake. Apple produced the first smartphone in 2007 and the first tablet in 2010. In 2015 there were 4.43 billion mobile phone users in the world, of which 2.6 billion had smartphones. In the US, 45% owned a tablet computer in 2014 and 92% owned a mobile phone; for younger adults aged 18–29, only 2% didn't own a mobile phone and 50% had tablets.
A large Finnish cross-sectional study on school-age adolescents published in 2012 concluded that more than two hours a day spent on computers was associated with a moderate/severe increase in musculoskeletal pain. In the following year, the average UK 18–24 year-old spent 8.83 hours a day in front of a PC, laptop or tablet. Neck pain per se has been a large problem for a long time, and surveyed repeatedly. A composite review of studies with good methodology by Fejer et al published in 2006 found that point prevalence of neck pain in the adult population ranged from 5.9% to 22.2%, with one study of the elderly finding 38.7% were in pain when surveyed. Generally, more urban populations had more neck pain, e.g. 22.2% of a large 1998 Canadian study had neck pain when surveyed.
Based on these surveys of neck pain prevalence, and adding to them the prevalence of thoracic pain and cervicogenic headache, it is reasonable to estimate that around one adult in six probably has pain in any, some or all of those areas right now. However the published epidemiological papers draw on raw data from surveys done at least 10 years ago, and there are indications that the numbers have been rising dramatically since then – as rapidly as the adoption of laptops, tablets and smartphones. This is reflected in the recent rise in the number of popular articles, news items and media discussions about the problem.

Pathogenesis

The iHunch is a multi-factorial problem.
generally has been treated with a profusion of approaches and modalities, including nonsteroidal anti-inflammatory drugs such as ibuprofen; pain relief medications such as acetaminophen; low dose tricyclic antidepressants such as amitriptyline for chronic problems; physical therapy which utilises a wide range of techniques and modalities; spinal manipulation from osteopaths, manipulating physiotherapists and doctors; massage; muscle strengthening programmes including gyms and Pilates; postural approaches such as the Alexander Technique; stretching approaches such as yoga; ergonomic approaches including setting up desktop computers correctly and frequent breaks; and surgery for severe structural problems such as osteophytic impingement on the cervical nerve roots and cervical disc herniation.
A biomechanical analysis of the iHunch indicates its standard, logical development from much flexed activity and its multi-factorial character.
A composite approach which covers each component of the problem is therefore likely to be most successful and lasting. Most of the general treatment approaches to neck pain cover only one aspect. A logical response should include as a minimum:
Strengthening muscles that cause neck retraction: