Text neck is a repeated stress injury as well as pain, sustained from excessive watching or texting on handheld devices for long periods of time. The dependence on mobile phones is increasing rapidly, and people spend long hours on their phones, which leads to various musculoskeletal problems. Individuals with this syndrome usually present with neck pain, restricted cervical range of motion, reduced muscle strength and endurance, altered cervical joint position error, along with postural alterations like forward head posture and rounded shoulders as well.

According to recent research, 79% of those aged 18 to 44 have their phones with them virtually all of the time, with only two hours of their waking day spent without them.

In the neutral position, an adult’s head weighs 10-12 pounds. With the flexion of the head, the load increases towards the neck, and the weight is calculated to be 27, 40, 49, and 60 pounds at 15°, 30°, 45°, and 60° respectively. People who use a smartphone frequently have a downward gaze to focus lower, and keep their heads in a forward position for lengthy periods, which can cause neck strain, eventually hastening the process of ageing in the cervical spine. The symptom can result from improper workstations, poor ergonomics, inadequate breaks, and prolonged improper postures.

Common symptoms of text neck

Common symptoms of text neck include headaches, stiffness, shoulder pain, and persistent neck pain. In more extreme situations, tingling or numbness in the fingers or arms could be present, suggesting that nerves are being squeezed.

Text neck, if ignored and untreated, can result in serious long-term consequences, such as flattening of the spinal curvature, early onset of arthritis, spinal misalignment, spinal degeneration, disc space compression, disc herniation, nerve or muscle damage, inflammation of cervical ligaments, nerve irritation, and an increase in spine curvature.

A case study

Take this case of a young IT professional. He came in with severe neck pain radiating to the right arm and to the thumb. He had developed neurological weakness in the form of a poor hand grip and an inability to extend the wrist.

An MRI revealed a huge C56 disc pressing on the right side of the C6 nerve root, leading to this catastrophe. He was immediately taken up for endoscopic removal of disc, decompression of the affected nerve root, followed by replacement by an artificial disc with the aim to retain movements at that level and to avoid adjacent disc degeneration. He regained all of his lost power and was pain-free immediately, and was able to rejoin work in a week.

Not all people however, end up with the above scenario, and not all require surgical intervention unless neurological weakness is detected. A personalised approach, along with community awareness are both factors that can play a vital role in the rationalisation of text neck syndrome.

Integrated postural training in such cases can be a beneficial approach for individuals, combining pain management with a focus on increasing the cervical range of motion, strengthening, stretching, and postural correction.

Physical therapy methods that include a patient-centered approach, home exercises, and postural correction are the prime aspects of managing this syndrome at an early stage to avoid later consequences.

Physiotherapy interventions can be done to treat text neck syndrome, some of which include local ultrasounds, manual traction and manual exercises, cervical muscle stretching, and McKenzie exercises. There is an increasing need for a structured treatment protocol in such individuals to avoid long-term complications, which are mostly seen at an early age.

Treatment options

Simple changes in lifestyle can often be part of the initial course of treatment. Pain can be relieved and further damage can be avoided with physical treatment, posture correction, stretching exercises, and screen time reduction. Also helpful are ergonomic workstations, supportive chairs, and regular pauses when using a laptop or phone.

Surgery might be considered in situations where the spine has sustained structural damage, such as slipped discs or significant nerve compression. To relieve pressure on the nerves, the standard treatment is to remove the injured disc part. A minimally invasive procedure can be used to accomplish this, resulting in a quicker recovery and less discomfort. Surgery is only advised in cases when conservative measures have failed and the problem interferes with day-to-day functioning.

Prevention is better than cure

It’s easier to prevent text neck than to treat it. Maintaining an active lifestyle, holding displays at eye level, and encouraging proper posture can all have a big impact. In the digital age, spinal health can be significantly protected by early awareness and conscious practices. Spinal issues don’t have to be permanent, but smartphones are. Maintaining a strong and healthy spine while being connected is possible with minor adjustments and consistent attention to posture.

(Dr. Mohit Muttha is a consultant spine surgeon at Manipal Hospital, Kharadi, Pune. He can be reached at Mohit.muttha@manipalhospitals.com)

All of us have experienced butterflies in the stomach just ahead of an important exam, nervousness as we’re headed for a job interview, or perhaps clammy palms just after we have risked our lives crossing a road in our country. Some amount of anxiety is normal, and even healthy — it may help alert us to a dangerous situation and focus our attention. An anxiety disorder however, goes beyond this. Anxiety disorders are the world’s most common mental disorders, says the World Health Organization (WHO), with an estimated 301 million people affected as of 2019. More women than men are affected by anxiety disorders. In India, as of 2017, a staggering 44.9 million people had anxiety disorders according to the research paper: ‘The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017’ in The Lancet Psychiatry.

What are anxiety disorders?

Anxiety is different from fear, though the two may often be confused. The American Psychiatric Association states that anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behavior, whereas fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger.

People with anxiety disorders experience fear worry that is beyond the occasional — it can be intense, excessive and hard to control. These feelings, the WHO states, are typically accompanied by physical tension and other behavioural and cognitive symptoms. They are difficult to control, cause significant distress and can last a long time if untreated.

In order for a person to be diagnosed with an anxiety disorder, in general, the anxiety must be out of proportion to the situation and must impact their ability to function normally.

Children, adolescents and adults can all experience anxiety disorders.

What are the types of anxiety disorders?

There are several different types of anxiety disorders. These include: generalised anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder, separation anxiety disorder and selective mutism. People can have more than one anxiety disorder.

Generalised anxiety disorder or GAD is the most common type of anxiety disorder. GAD is characterised by constant, excessive worrying, tension and fear, often about everyday responsibilities such as those at work or at home or even about minor, routine tasks and chores. This worrying often can’t be controlled, it may be persistent and far more intense than the situation warrants.

GAD can develop slowly, sometimes from childhood or adolescence, or from adulthood.

What are the signs and symptoms of GAD?

Symptoms can be psychological and physical. Some common symptoms include: trouble controlling worries and nervousness, feeling restless and being unable to relax, feeling irritable, having trouble falling asleep or staying asleep, sweating, trembling or shaking, heart palpitations, an inability to concentrate, difficulties in making decisions, dry mouth, sweating, shortness of breath or rapid breathing, nausea and stomach upsets, tingling in the hands or feet, cold, sweaty hands and the urge to avoid things that cause the anxiety.

Anxiety disorders increase the risk for depression and substance use disorders as well as the risk of suicidal thoughts and behaviours, says the WHO.

What causes anxiety disorders?

The exact cause of anxiety disorders is unknown. They are believed to stem from a combination of factors including genetic, environmental and psychological. Researchers believe chemical imbalances of neuro-transmitters and hormones could play a role. Other factors that could increase the risk for an anxiety disorder include severe family or environmental stress, experiencing a traumatic event, living through abuse and long-term illnesses. Genetics also play a role as anxiety disorders can run in families.

According to the WHO, anxiety disorders are closely related to and affected by physical health. Many of the impacts of anxiety (such as physical tension, nervous system hyperactivity or harmful use of alcohol) are also known risk factors for diseases such as cardiovascular disease. In turn, people with these diseases may also find themselves experiencing anxiety disorders due to the difficulties associated with managing their conditions.

How are anxiety disorders treated?

After ruling out physical problems that may be causing the symptoms, your healthcare provider may refer you to a mental health professional for a diagnosis.

Treatment can include a combination of medication and psychotherapy. Medication can include anti-depressants and anti-anxiety medicines. Medicines may take time to work and some people may have to work with their doctors to find the right combinations, dosages and duration of medication.

Cognitive behaviour therapy, which is a form of therapy, is also commonly used to treat anxiety disorders. This involves learning different ways to think, react and behave, after identifying thought patterns that cause anxious feelings.

Self-care can also play an important role. This includes exercising regularly, cutting down on alcohol, quitting smoking, limiting caffeine, learning and practicing relaxation techniques, managing stress, meditation and participating in in-person or online support groups.

Although highly effective treatments for anxiety disorders exist, only about 1 in 4 people in need (27.6%) receive any treatment, the WHO notes. Barriers to care include lack of awareness that this is a treatable health condition, lack of investment in mental health services, lack of trained health care providers, and social stigma.

It is important to see your healthcare provider if you are experiencing symptoms of an anxiety disorder.

Twice a week, Mohamed Attiya’s wheelchair rattles over Gaza’s scarred roads so he can visit the machine that is keeping him alive.

The 54-year-old makes the journey from a temporary shelter west of Gaza City to Shifa Hospital in the city’s north. There, he receives dialysis for the kidney failure he was diagnosed with nearly 15 years ago. But the treatment, limited by the war’s destruction and lack of supplies, is not enough to remove all the waste products from his blood.

“It just brings you back from death,” the father of six said.

Many others like him have not made it. They are some of Gaza’s quieter deaths from the war, with no explosion, no debris. But the toll is striking: Over 400 patients, representing around 40% of all dialysis cases in the territory, have died during the 18-month conflict because of lack of proper treatment, according to Gaza’s Health Ministry.

That includes 11 patients who have died since the beginning of March, when Israel sealed the territory’s 2 million Palestinians off from all imports, including food, medical supplies and fuel.

Israeli officials say the aim is to pressure Hamas to release more hostages after Israel ended their ceasefire.

Coordination of Government Activities in the Territories (COGAT), the Israeli military body in charge of coordinating aid, declined to comment on the current blockade. It has said in the past that all medical aid is approved for entry when the crossings are open, and that around 45,400 tonnes of medical equipment have entered Gaza since the start of the war.

Hardships mount for Gaza patients

Mr. Attiya said he needs at least three dialysis sessions every week, at least four hours each time. Now, his two sessions last two or three hours at most.

Israel’s blockade, and its numerous evacuation orders across much of the territory, have challenged his ability to reach regular care.

He has been displaced at least six times since fleeing his home near the northern town of Beit Hanoun in the first weeks of the war.

He first stayed in Rafah in the south, then the central city of Deir al-Balah. When the latest ceasefire took effect in January, he moved again to another school in western Gaza City.

Until recently, Mr. Attiya walked to the hospital for dialysis. But he says the limited treatment, and soaring prices for the mineral water he should be drinking, have left him in a wheelchair.

His family wheels him through a Gaza that many find difficult to recognise. Much of the territory has been destroyed.

“There is no transportation. Streets are damaged,” Mr. Attiya said. “Life is difficult and expensive.” He said he now has hallucinations because of the high levels of toxins in his blood.

“The occupation does not care about the suffering or the sick,” he said, referring to Israel and its soldiers.

A health system gutted by war

Six of the seven dialysis centres in Gaza have been destroyed during the war, the World Health Organisation (WHO) said earlier this year, citing the territory’s Health Ministry.

The territory had 182 dialysis machines before the war and now has 102. Twenty-seven of them are in northern Gaza, where hundreds of thousands of people rushed home during the two-month ceasefire.

“These equipment shortages are exacerbated by zero stock levels of kidney medications,” the WHO said.

Israel has raided hospitals on several occasions during the war, accusing Hamas of using them for military purposes. Hospital staff deny the allegations and say the raids have gutted the territory’s health care system as it struggles to cope with mass casualties from the war.

The Health Ministry says over 51,000 Palestinians, mostly women and children, have been killed in Israel’s offensive, without saying how many were civilians or combatants.

Hamas-led militants killed some 1,200 people, mostly civilians, and abducted 251 in the October 7, 2023 attack that triggered the war.

Officials say hundreds of patients have died

At Shifa Hospital, the head of the nephrology and dialysis department, Dr. Ghazi al-Yazigi, said at least 417 patients with kidney failure have died in Gaza during the war because of lack of proper treatment. That’s from among the 1,100 patients when the war began.

Like Mr. Attiya, hundreds of dialysis patients across Gaza are now forced to settle for fewer and shorter sessions each week.

“This leads to complications such as increased levels of toxins and fluid accumulation… which could lead to death,” Mr. al-Yazigi said.

Mohamed Kamel of Gaza City is a new dialysis patient at the hospital after being diagnosed with kidney failure during the war and beginning treatment this year.

These days, “I feel no improvement after each session,” he said during one of his weekly visits.

The father of six children said he no longer has access to filtered water to drink, and even basic running water is scarce. Israel last month cut off the electricity supply to Gaza, affecting a desalination plant producing drinking water for part of the arid territory.

Mr. Kamel said he has missed many dialysis sessions. Last year, while sheltering in central Gaza, he missed one because of an Israeli bombing in the area. His condition deteriorated, and the next day he was taken by ambulance to Al-Aqsa Martyrs hospital.

“The displacement has had consequences,” Mr. Kamel said. “I am tired.”