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Text Neck and Loupe Neck: A Global Epidemic

ErgoPractice News – April 2018
By Jin Chang PhD


Extensive use of smartphones and other electronic devices is resulting in a harmful and dangerous physical condition known as Text Neck. The phrase Text Neck – originally coined by Dr. Dean Fishman, a chiropractor in Plantation, Florida – describes the repeated stress injury to the neck caused by excessive use of mobile devices with poor neck posture, looking down at the screens of mobile devices, and “texting” for long periods of time (Figure 1).1 Text Neck is becoming a global epidemic among all populations in the digital age.

A similar physical condition has been affecting clinicians such as dentists, hygienists, surgeons, and veterinarians. The widespread use of improperly designed and fitted loupes by clinicians has resulted in the repeated stress injury to the neck which we may call Loupe Neck. Improperly fitted loupes force users to bend their head forward and down to see their target, increasing the weight on the cervical spine and causing neck and back pain that can debilitate clinicians.2

How Does Loupe Neck Affect Clinicians?

On average the human head weighs between ten and twelve pounds (Figure 2).3 With a neutral posture this weight is easy for the neck to hold upright, but as the neck bends forward and down, the weight on the cervical spine begins to increase. At a 15-degree angle this weight becomes 27 pounds; at 30-degrees it is 40 pounds; at 45-degrees it becomes 49 pounds; at 60-degrees, the typical head tilt we see from mobile device users, it is 60 pounds.3, 6

According to the Text Neck Institute, founded by Dr. Fishman, this poor neck posture can result in serious permanent damage including flattening of the spinal curve, the onset of early arthritis, spinal degeneration, spinal misalignment, disc herniation, disc compression, muscle and nerve damage, loss of lung volume capacity, and gastrointestinal problems.1

Clinicians who spend years bent over their patients are at an increased risk of developing these serious health issues. Working pain is already an epidemic for clinicians due to a lack of ergonomic education. Generations of clinical professionals are learning about the dangers of Loupe Neck only after they develop pains or injuries, but they can be avoided.

Practicing Without Neck Pain

Eliminating both Text Neck and Loupe Neck is very simple: instead of bending down to read a text message or to view your subject during a procedure, keep your head up and look down with your eyes. Alternatively, raising mobile devices to be in your line of sight removes the need to bend your head and neck to see the screen.

In order to protect yourself from Loupe Neck, clinicians must find the correct loupe for their physical requirements. Industry safety regulations focus on the health and comfort of the patient, but not on the tools clinicians use every day, and every clinician has different physical features such as height and nose shape that will influence the ergonomic value of their loupes. There are several rules clinicians may use to find ergonomically correct loupes and alleviate neck stress or chronic neck pain:

  1. When looking for your first pair of loupes, make sure that your head tilt with loupes is less than 25-degrees.7 Ergonomic educators have found that tilting your head more than 25-degrees forward causes strain on the neck and back,7 though it’s important to note that many ergonomists recommend a head tilt of less than 20-degrees.
  2. If clinicians are not yet living with significant neck stress despite using loupes, they should evaluate their current pair. If the loupes force a head tilt that is more than 25-degrees, consider remaking the loupes. If a remake is not possible, consider purchasing a new pair of loupes which allows for a healthy neutral head tilt of less than 25-degrees. Loupe Neck is a condition that develops from the use of ergonomically incorrect loupes over many years, and may not result in pain and injuries for five to ten years.
  3. If clinicians have been using loupes and feel neck stress or pain after procedures, they should first evaluate that their loupes allow them to keep their heads up. If using a brand that forces an unhealthy head tilt (Figure 3A), consider finding new loupes that allow for a head tilt angle that is less than 25-degrees (Figure 3B). Oftentimes clinicians attribute their working pain to old injuries rather than poor neck posture. Years ago when I spoke about loupe ergonomics at a medical conference, one surgeon told me about two of his colleagues who were experiencing varying levels of neck pain and had been for some time. One clinician, who had been practicing for about five years, attributed his neck pain to a bad pillow. The other, who had been practicing for more than 10 years and whose pain was so severe he was thinking about neck surgery, thought his old sports injuries were flaring up. Rather than blaming a bad pillow or sports injury, clinicians should improve their working posture by finding ergonomically correct loupes.

SurgiTel’s Ergonomic Solution

SurgiTel has developed a product family that strives to eliminate working pain by utilizing MultiPoint Ergonomics™. With MultiPoint Ergonomics™, loupes clinicians are able to sit comfortably upright, protecting their back from strains throughout a long workday, and keep their head tilt within a safe range. SurgiTel is able to make custom-fitted loupes for every physical feature so all clinicians can find an ergonomic solution.

In addition to ergonomic loupes, there are two other companion productions for a pain-free practice: headlights and stools/chairs. SurgiTel offers a complete package of ergonomic products. It is noted that many LED headlights may be dangerous to eyes.8, 9 SurgiTel’s achromatic LED headlights offer the best color accuracy and are safest for the eyes.

Vision and Ergonomics at Work

Establishing safe working practices is an integral part of maintaining a long and pain-free career. Discover how SurgiTel’s products can help your practice. For more information, or to try our products in person, contact your local representative.


  1. “Text Neck: A Global Epidemic.” The Text Neck® Institute.
  2. Humphrey, Dee. “My 6-Year Clinical Career from Non-Ergonomic Loupes.” SurgiTel. SurgiTel Testimonials, April 17, 2017.
  3. Sullivan, Laura. “Keep Your Head Up: ‘Text Neck’ Takes A Toll On The Spine.” NPR. NPR, November 20, 2014.
  4. Khaleeli, Homa. “Text Neck: How Smartphones Are Damaging Our Spines.” The Guardian. Guardian News and Media, November 24, 2014.
  5. Hansraj, Kenneth K. “Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head.” Surgical Technology International 25 (November 2014): 277–79. PMID: 25393825.
  6. Bradford, Alina. “How to Avoid ‘Text Neck’.” CNET. CNET, May 25, 2016.
  7. Pulat, Babur Mustafa. “Chapter 7.” Essay. In Fundamentals of Industrial Ergonomics, Seconded., 177. Prospect Heights, IL: Waveland Press, 1997.
  8. Stamatacos, Catherine, and Janet L Harrison. “The Possible Ocular Hazards of LED Dental Illumination Applications.” The Journal of the Tennessee Dental Association 93 (October 2013): 25–29.
  9. Price, Richard B.T., Daniel Labrie, Ellen M. Bruzell, David H. Sliney, and Howard E. Strassler. “The Dental Curing Light: A Potential Health Risk.” Journal of Occupational and Environmental Hygiene 13, no. 8 (May 25, 2016): 639–46.