Episode Transcript
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Hello, welcome. This is episode 73 of Yoga Researchand Beyond. We are talking about text neck
today and neck pain. We'll talk about what textneck is and if text neck really does cause
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neck pain. I'm your co-host, Oriana, founderof Yoga Research and Beyond. I'm a yoga teacher
strength trainer in New York City. and co-founderof New York Stretch. I'm Jules and I'm co-hosting
with Ariana today. And I teach mostly yoga biomechanicsin the form of continuing education and advanced
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yoga teacher training. And research literacyis a big part of all of my programs, which
is why we're here together. Jump right in, jumpingright in to the paper. It's a pre-proof, but
we'll go into what that means. The title isNeck Pain and Text Neck Using Hill's Criteria
of Causation, a Scoping Review. It's from theJournal of Body Work and Movement Therapies.
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It's by Paula Oxley-Adora, don't know how topronounce it, sorry, Rosenda and her colleagues.
I think this research was done in Brazil, whichexplains my inability to pronounce the names.
And this was done in December of 2024. As Imentioned, it's a journal pre-proof. Joel,
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what's a pre-proof? Wow. A pre-proof generallymeans that the paper has gone through peer
review, but it isn't like typeset and formattedand properly edited. So you often see typos.
and other errors. And I will say that for beinga pre-proof, I was bracing myself, because
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I've seen some pretty bad ones. And this onewas pretty good. I found it really readable
and understandable without a lot of conflictingstatements. We once read a pre-proof in one
of my mentoring program and. We didn't realizeit was pre-proof because it was, we just kind
of overlooked it and we were just talking andwe felt like we were being the peer reviewers.
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We kept finding mistake after mistake. It wasreally interesting, but this one seems to be
pretty good. Just it, usually what you'll seeis like in this one, there's a lot of weird
spacing. It hasn't been formatted. It's notall condensed. It's not really ready for publication,
but it does have a DOI and it can be cited.And generally once it's ready, they will replace
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it with. the final paper. It's just somethingthat we can do now that we have the internet.
You know, we can just say, hey, it's ready whilewe get everything organized. And you might
see it all also called like an article and press.That's another name for it. So you might see
that. Got it. So I also thought it was reallyreadable. I found that too. The purpose of
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this study, this is the question that they askis, does text neck cause... neck pain, pecs
neck, but it is basically it's just the positionyour neck goes into when you're looking down
at your smartphone or device. So it involvessome neck flexion and it's associated with
poor posture. The way that they, they did thisresearch, it's a scoping review, which means
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it's like a broad overview rather than a detailedanalysis or like. statistical analysis of specific
studies. One description I saw of a scopingreview is that it provides a roadmap. It's
like a roadmap of research, which I liked that.That was helpful. So the way that they, once
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they looked at all of these studies and thisscoping review, they had like 21 studies that
they pulled together and they looked at themall and used what's known as Hill's criteria
of causation, which I had never heard of before.And it's used a lot in research to determine
if there is something that is causing somethingelse. It was developed by Sir Austin Bradford
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Hill back in 1965 to observe those associations.And there are nine criteria in the guidelines.
I'm not going to go over all of them unlessyou want me to mention all of them, Jules,
but I'll mention four of them. One is involvingtime. So did the cause or what you think is
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the cause that it happened before the effect.That's important. Sounds really obvious, but
that's an important one. How strong is the association?So an example of a strong association is smoking
and lung cancer. Another one is consistency.Uh, is the same association observed in many
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populations at different times and differentcircumstances. And then the other one, another
one I thought was important is gradient, gradientor dose response, which is if it's the cause,
you would think higher exposure to that causewould cause more of that effect. So that's,
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that's the fourth one. um, I thought was mostinteresting, but there is, there are five others.
Yeah. I think, uh, biological plausibility isalso a good one, just like, especially for
tech snack, like, is it plausible that being,having your head down could cause tissue damage?
You know, is that biologically plausible? ButI think we'll go over the rest of them kind
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of as we go through the results or what theirdetermination was in the paper, so you'll get
some exposure to them. I think if it's okay,I'll just do a little riff on correlation,
association, and causation just for, just tomake sense of all this. Like, why is this important?
Because it's really easy to understand thatthere's an association and then think that
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there could be a causation and they're not reallythe same thing. So I found a little blurb in
Nature, which is a great publication. And itsaid correlation implies association. but not
causation. And conversely, causation impliesassociation, but not correlation. And that's
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a lot to wrap your head around because you'relike, what's really the difference, especially
because we use association and correlation asthe same thing in everyday colloquial language.
But technically, they're not quite the samething when it comes to statistical analysis.
And so like, as Ariana mentioned, you know,Cause and effect is a very specific relationship.
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Something needs to precede the variable thatis the cause, needs to precede the outcome,
which is the effect. And so just because twothings happen doesn't automatically imply that.
So let me give an example of association. It'sa very, excuse me, it's a very general relationship
and it's usually somewhat dependent. But dependentdoesn't mean causation either. So the association,
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let me give an example. This is the one theyused in the nature. People who drink four cups
of coffee a day tend to have less incidenceof skin cancer. Okay, so that's an association.
There's a variable, four cups of coffee a day,and then there's, you know, that's the dependent
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variable, right? And the other, the outcomeis less skin cancer or more infrequent incidence
of skin cancer. And so it's easy to think coffeeis a cause for less skin cancer, right? It's
easy to think that, but the reality is it'sprobably because coffee drinkers have office
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jobs and spend more time indoors, right? Butit is still dependent. So there is an association
that is dependent, but it's not a cause andeffect. And that's what I think is so hard
for us to wrap our head around. around, especiallyin today's world with news and social media.
So you really have to step back and think aboutit. Okay. So now let's go to correlation because
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the correlation is not just an association orcausation either. A correlation is where two
variables, and you mentioned this is part ofbeing Hill's criteria as well, but two variables,
they have a relationship with each other, likean example would be like an increasing relationship
or decreasing trend. So what you would needfor there to be a correlation would be that
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if you drink five or six or seven cups of coffeea day, you would have less and less and less
skin cancer. That's a correlation. It stilldoesn't tell you that coffee is a cause of
reducing your chance of skin cancer, but thatwould be a correlation. So it's more that there's
two variables involved and that the two of themhave a trend that is reflected of the other.
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versus an association is just more of like thisdependent thing, which is again, not causation.
So I know it's so overwhelming, but I thinkin text neck, that's why I love this paper,
because it's so easy to go on social media andsee text neck with red flames shooting out
the back of your neck and that it's a causeof pain. And so just because two things are
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happening, right? Doesn't necessarily mean thatone causes the other. So, you know, could,
Could there be other factors of using your phoneall the time, social factors of using your
phone all the time that are contributing topay? Yeah.
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The concept of text neck always makes me smilebecause we've been reading for centuries with
our heads down. I know. Well, that's. That'sone of the criteria in Hill's criteria of causation.
So it's an analogous example. So if we lookat, and we're just kind of jumping ahead, but
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that's fine, no problem. But if we look at otherways that our heads are down, reading newspapers,
mashing corn to make tortillas, doing laundry,working in the fields. So if we look at analogous
situations where our head is inflection, dowe have the same incidence? And so... it, you
know, spoiler alert, it did not pass the criteriatest for that one. Um, but that what? Yeah.
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Here's another spoiler alert. Yeah. Let's justget into it. We don't have to be in order.
No, I just love this. None of the criteria weremet. Oh, yes. Yes. Like not a single one of
the criteria were met. Yeah. Okay. Yeah. Sothe funniest one. Yeah. The first one is time
temporality. So there was no evidence. showingthat Tex-Neck preceded the neck pain. There
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were weak associations, so there was no consistencybetween the links of Tex-Neck and neck pains.
There was no biological plausibility. That'sa big one. The research on spinal mechanics
suggested that our necks can tolerate much moreload than Tex-Neck posture creates. the dose
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response, the gradient, like there was the moreexposure people had to Tex neck did not correlate
with more pain. So those are the five that Ithink those were the five. You were interesting.
Yeah. On the biological plausibility, they wrote,none of the studies presented convincingly
verified that the habit of flexing the neckwhile using a smartphone could cause tissue
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damage. You know, but again, when you see thesocial media meme. It's so easy to fall into
the logical fallacy, right? Yeah, yeah. Someof the others were consistency. So there was
no repetition of finding in different populationsand locations and over time. And there was
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no consistency in any of the studies. So thatwas another one that was out. Another one of
them is specificity. It's like, so they weresaying positioning and cervical flexion is
not characterized as the only capable. thingthat reproduces neck pain. So that was another
one of the important criteria. It has to beso specific to this. It was like, you know,
lots of things cause neck pain. So like, howcan we blame just being inflection? Let's see,
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you've covered the next few. What else was there?Coherence, that was a really good one. So they
basically brought up the biopsychosocial model,saying that it's widely recognized that neck
pain is a multifactorial condition. So coherencekind of had an overlap with specificity. And
then the analogy one that we already talkedabout. And I can't say the word analogy without
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laughing because we were on a trip recentlyand had a friend doing a crossword puzzle and
it's just a whole inside joke about the pronunciation,but it's, I will have, we will have that forever
between us. Shout out. Yeah. So yeah, the, Ialready mentioned it, the analogy, right? That
there's all kinds of other activities, knitting.We're not seeing research papers saying knitting
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and neck pain. Yeah. So if it's not the textneck, what is it? So Jules mentioned the biopsychosocial
model. So yeah, so there's thinking factorslike stress levels, lifestyle and psychosocial
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elements could be involved. And so with someonewho's got neck pain, don't assume. Oh, hey,
are you on your phone a lot? And you know, well,and the real thing is, is someone that has
neck pain might be on their phone all the timebecause we're all on our phone all the time.
But they just because they're both happeningdoesn't mean that one causes the other, you
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know? Yeah, it could be the stress that we getwhen we're reading. Yes. Things going on. in
the world. It could be not getting outside andgetting fresh air. It could be, you know, yes,
it could be a million things. Yeah, it's notthe phone's fault. Yeah, it's not the phone's
fault. So yeah, so this, I thought this wasa fun, cool study. I liked it. Yeah. Any limitation?
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that you thought were... I didn't really lookat those because I was just kind of focusing
on their technique. They basically said it wasjust, I mean, they have a paragraph on it,
but basically that it doesn't look at statistics.Like they were just doing an analysis, just
a scoping review, of course. And that we'realways limited by the type of research that's
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available. I don't think there's a- It's interestingthat they couldn't, they wouldn't have been
able to do a statistical meta-analysis becauseof the nature of the research that's available
on that. So yeah, but I think they were so straightforwardin the type of review that it was that it wasn't
really a limitation, like for me anyway. Yeah.But yeah, I think that's it. I think so too.
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Okay, cool. Great episode. All right, nice.Another one. In the bucket, thank you for joining
everybody. And please subscribe, share withyour fellow yoga teachers and let's keep the
conversation going about how we can use researchto inform and inspire our teaching. See you
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next time.