Tech Neck: How to Improve Your Posture and Protect Your Spine

Dr. Lombardi: If we flex our neck down, touch our chin to our chest, similar to the posture that we would have during texting, it's no longer 10 to 12 pounds through our discs. It's something closer to 60 pounds of stress that our discs are absorbing.

Courtney: Welcome to Health Matters, your dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison.

This season on Health Matters, we're covering your health from A to Z, asking our experts to break down the health topics and wellness trends we're all curious about. Today, we're at the letter P for posture. We're talking with Dr. Joseph Lombardi, an orthopedic spine surgeon at Och Spine at NewYork-Presbyterian, to learn how tech neck affects our spines, the dangers of sitting and slouching for too long, and just how our posture can impact our overall health. He also shares simple steps we can all take to improve our posture and protect our spines.

Dr. Lombardi, thank you so much for joining us on Health Matters today.

Dr. Lombardi: Hey, Courtney. Thanks so much for having me. I'm excited to be here.

Tech Neck and the Hidden Stress on Your Spine

Courtney: So we're here today to talk with you about the importance of our posture and ways we can improve it, and how it impacts our health. To start, can you give us an introduction to the spine and what it's made of?

Dr. Lombardi: It is a unique structure in the sense that there are bony components and soft tissue components. And so if you think about the disc as really a shock absorber between the vertebra, and we have numerous vertebra throughout the cervical, thoracic, and lumbar spine, and each one has this shock absorber between it. And that has a bunch of functions, but chief among them is it does allow for motion of the spine, and it's one of the greatest gifts that we have, but that's what c- can also break down and be one of the biggest problems for us as well.

Courtney: A lot of us, like me right now, are sitting for hours, or looking at our phones, on our computers. What is that actually doing to our spine?

Dr. Lombardi: Great question. We really have become, in the last 50, but even more so the last 20 years since the advent of the computer and internet, really a much more sedentary population. And we, we really weren't designed or evolved to be sedentary. And so what we see, particularly with biomechanical studies, is that there are certain positions that we take with the spine that do dramatically increase the stress on our discs.

Courtney: Looking at our phones all day, hunching over our computers, are those examples of that term tech neck or text neck?

Dr. Lombardi: Yes. What text neck is referring to is looking down at a computer or a phone, and what we see is that certain posturing will dramatically increase the stress on our discs. Our skull weighs between 10 and 12 pounds, so if we're holding our neck in a neutral position, that's 10 to 12 pounds of stress or weight through the discs or shock absorbers in our neck. But as we flex our neck down, we do start to see dramatic increase in the equivalent stress through our discs. So for example, if we flex our neck down, touch our chin to our chest, similar to the posture that we would have during texting, it's no longer 10 to 12 pounds through our discs. It's something closer to 60 pounds of stress that our discs are absorbing.

Courtney: 60 pounds, wow.

Dr. Lombardi: Yeah. So that's like a couple of bowling balls' worth of weight that our discs are then holding up. And i- it's important to recognize that our discs are designed to do this. The discs are comprised of anywhere between 70 to 90% water, and so they are really designed to hold a lot of stress. But over years or decades, that can break down.

Why Posture Matters for Long-Term Spine Health

Courtney: Why does posture matter for our overall health? What's at stake if we ignore it?

Dr. Lombardi: A really good question. We adapt to poor posture. It does put more stress on our discs, and our discs are designed to do that. But over the course of years to decades, as we bear more stress on our discs, those things that suck the water in, keep our discs young and healthy and hydrated, those start to break down and they dry out. And when our disc then dries out, we lose the mobility and the flexibility, and that's when we start to have breaks or cracks in the disc, and we get disc herniations. And so that's really the long-term concern with poor posture, is we degenerate our discs faster, and then we have those bad downstream effects like disc space collapse where you'll have bone on bone will start rubbing together because we don't have that nice cushion anymore. Or you have your disc herniations where the disc material will squirt out and actually compress on the nerves, and that's those patients who come in with terrible buttock or leg pain, numbness, tingling, or weakness, what we colloquially refer to as sciatica. The vertebral discs are incredibly flexible tissue. Even throughout the day, from the time you wake up to when you go to sleep, your discs will lose about 10 to 20% of their water volume. And when we go to sleep at night, that water volume is then brought back in. So we are slightly shorter when we go to sleep at night than what we are when we wake up. But that's the amazing adaptability of the discs. However, over years to decades, we do start to lose water content of the discs. They lose their flexibility. They get stiff. And that's when bad things happen.

Courtney: That's fascinating. So we're a little shorter when we go to bed.

Dr. Lombardi: Yeah. Now, keep in mind, this isn't an inch or so taller. We're talking about a millimeter, if that. But it does speak to how, when we get older, as we age, we do get shorter. Part of that has to do with the overall drying out of our discs and our loss of disc height, among other things.

Ergonomics, Sitting, and Building Better Habits

Courtney: So I'm wondering, is there a quick way for someone listening to check their posture right now? What can we do to kind of straighten up?

Dr. Lombardi: The biggest culprit is that we do spend quite a lot of our time on computers. I'm on a laptop with you right now, and I'm breaking my own rules. The laptop is on the desk and I'm looking down probably 15 to 20 degrees, which we really don't want. The goal is to keep our neck in a more neutral position. So what I tell patients is that you really want the top of the screen to be Just above your eye level. I usually say two inches above your eye level. That'll bring the center of the screen more in line with your eye level, and that will help keep your neck in a neutral position. So that's immediately an very easy fix that we can do to help a- and over time reduce the stress on the discs in our cervical spine.

Courtney: So since a lot of us are sitting at computers all day, any other tips for our work station? Where should our arms be, our legs? Can you describe a really good setup for good posture?

Dr. Lombardi: We want the computer to be at arm length away. We want the screen to be just above, uh, our eye level to keep our neck in a neutral position. That's a good setup for the cervical spine. In terms of the lumbar spine, just sitting down increases the stress on the discs in our lumbar spine by quite a bit. In fact, close to 120 to 150% of the stress increases just as we sit. Moreover though, it's slouching that is really what dramatically increases the pressure in the lumbar spine. When we slouch, that stress rises up to 200% of the normal stress through a disc. I do like lumbar pillows or lumbar support pillows to help keep that rounded curve to the lower back to help prevent slouching as well. And importantly, get up and take breaks. As we stand, the stress through our discs dramatically decreases. And so get up, take breaks, walk around, particularly if you're starting to feel that low back pain as you're sitting for a while.

Courtney: What about a standing desk? Is that something you'd recommend?

Dr. Lombardi: Standing desks are great, particularly if it's a patient who already has disc pathology, like disc bulges. These are patients that will come in and tell me that they start to get lower back or even leg sciatica pain after sitting for a while.

Courtney: I think we've all heard, "Sit up straight, don't slouch," since we were kids. But zooming out, what does it mean to actually have good posture, just broadly?

Dr. Lombardi: There are really two components to that. One is the actual physical posture which we spoke about, trying to not slouch. But how do we accomplish that? That's where we really want to work on our core. The abs actually are part of this core or cylinder that wraps around the spine and helps give stability to the spine. The other component is your posterior chain or your, what we call the erector spinae musculature, the muscles in the back. By keeping your core and your posterior chain strong, that does dramatically help this posture, and what that really means is it's giving stability to our lower back.

Exercises, Prevention, and When to See a Doctor

Courtney: So what are some exercises we can do to improve our core strength and our posture overall?

Dr. Lombardi: I do have some favorite exercises that I'll tell patients to do at home. One physical therapist whose school of thought I really like, his name's Dr. McGill, and he has the big three lumbar spine exercises, and they're largely isometric exercises, meaning that the length of the muscle's gonna remain stable. Those are really effective for helping to build core strength. One is the bird dog exercise. So that's where you'll be on your hands and knees. You'll extend your right arm and your left leg at the same time. Other exercises are planks, and then there are the modified version of a crunch as well. And so those are three really good exercises for our core. For our neck, I like simple exercises. One is to rest your jaw in a neutral position, and then you pull it back almost into your neck. And so that's helping to push your head back and hold your head back, and that's engaging the muscles in the back of your neck. And so, uh, I'll tell patients to try to do that 10 times every hour. But if you are really struggling with this, I'd recommend getting in touch with a physical therapist who can do a full body evaluation and really understand where your weak points are.

Courtney: These are so helpful. Thank you. Any exercises that people should be cautious about?

Dr. Lombardi: Yeah, squats and deadlifts get a bad rap. They're dangerous when our form breaks down and when our core engagement and posterior chain engagement starts to fatigue, and that's when the stress goes into the discs and we get those herniations. If you're able to maintain really good form through your squats and deadlifts, you can do it, and that's what I tell my body builder patients. It's just about being smart and understanding when you're fatiguing and stopping there. Other exercises that do tend to stress the cervical spine are overhead weighted activities. And so whenever patients do those, I usually ask them to do them in a seated position. Keep the back of your head against a seat to help hold your neck in a neutral position.

Courtney: How much of a person's back pain or spine issues happen as a natural result of aging, or can lifestyle habits speed it up or prevent it?

Dr. Lombardi: There's a lot of reasons why we do get degeneration. Part of it is naturally aging. If you look at studies where we MRI patients off of the streets, uh, about half of patients will have some sort of disc pathology, disc degeneration, even as early as their 30s. So disc degeneration, loss of disc height, loss of water content from our discs, that's completely normal. It is a part of aging. However, some people do have this process happen faster than others, and that's where both genetics come into play as well as environmental factors. We see patients who are manual laborers or those who did a lot of heavy lifting in their life. They do tend to have more rapid wear or degeneration of their discs. You can be an active person, you can be an athlete, you can lift heavy objects and never injure your back as long as you maintain good form and good posture. When we're younger, we have strong cores, we have strong backs. As we age, those things start to break down, particularly as we engage in more sedentary lifestyles. What I tell patients is that I want them to think of spine health not as a once in a while thing, but as something that should be maintained every day.

Courtney: I also wonder how much stress has to do with it. I feel like when I'm stressed, it's so easy to hunch up.

Dr. Lombardi: There's a huge evolving body of evidence that connects stress to lower back and neck pain. So stress certainly can add into it. We do see patients who are more depressed are more prone to having back and neck symptoms. So that's part of looking at the patient as a whole and understanding if there is stress in their life, ways that we can address that. More often than not, that does actually help our neck and back.

Courtney: We also see, like, posture correcting braces and garments. Are those something you recommend at all?

Dr. Lombardi: Those instruments kind of become a crutch, and they almost in a way will have the reverse effect of what we want. Ultimately, our goal, remember, is to keep a strong, stable core to support our spine. When we start using those braces, it kind of takes the place of our muscles. Our muscles get fatigued, they get atrophied, and we might end up worse than where we were to begin with. And so in an acute situation where you have a really bad muscle strain and you have to get over that inflammatory cascade, I'm okay with that. Long-term use of those I really try to steer patients away from because that will just cause the muscles to be, quote-unquote, lazy, and we'll actually lose our core strength and end up worse than where we started.

Courtney: So when should people see a doctor? When does posture-related discomfort cross the line into something you should get checked out?

Dr. Lombardi: Back pain is probably more muscular in nature, although it can be seen in the setting of arthritis of the back. It can be seen in some instances with disc pathology. But things that we really start to worry about is when you start to have radiating pain in the arms or legs, numbness and tingling in the arms or legs, or progressive weakness. Other things that worry us are if there is a progressive imbalance, if you feel like your hands are clumsy, you're dropping objects, or maybe you're falling, having difficulty buttoning buttons or signing your name, or if we start to see rapid changes in bowel and bladder function, numbness and tingling in the groin and genitalia. These are all signs that this is beyond a muscular strain. This is beyond a simple disc issue. There's some neurologic compromise happening here, and that's when we would seek medical care and get a better sense of what's the cause of these symptoms that you're having.

Courtney: Are there any takeaway messages you want listeners to walk away with when it comes to their posture?

Dr. Lombardi: I want all my patients to live an active lifestyle and enjoy those things that make them happy. Back and neck pain is incredibly common in today's day and age, but recognize that there are things that you can do to fix it, and that starts with having good posture at your desk, having good ergonomics, and doing daily exercises for your neck and lower back, like the ones we talked about, to keep your core in good, healthy shape and your neck in good, healthy shape. And these will have long-term effects that prevent back and neck issues from happening in the future.

Courtney: Dr. Lombardi, thank you so much for such a wonderful conversation. We really appreciate you being here with us today and all these wonderful tips on how to improve our posture.

Dr. Lombardi: Thank you so much for having me.

Courtney: Our many thanks to Dr. Joseph Lombardi. I'm Courtney Allison. Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests.

To learn more about Dr. Lombardi's work with patients, check out the show notes. NewYork-Presbyterian is here to help you stay amazing at every stage of your life. Join us next time when we talk about addiction and quitting. That's in two weeks right here on Health Matters. So you don't miss it, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.