The Study of Me

Why I started this project

In contemporary society, the growing dependency on technology in teenagers' day-to-day lives has contributed to an increase in back and neck problems. While the majority of public discussion is focused on issues related to social media and mental health, the physical consequences of technology use are often overlooked.

Extended periods of sitting and screen-based activities cause the neck and upper back to be exposed to continuous low-level loading which leads to muscle fatigue, pain, and posture changes. The condition associated with these symptoms is known as Upper Crossed Syndrome (UCS) which is the tightness and weakness of muscles in the neck, shoulders, and upper back [1].

My problem

Over the last 3 years I have been struggling with upper back and neck pains. It started as a slight discomfort which gradually became increasingly uncomfortable over the years. As a regular teenager would, I initially dismissed the problem as a short term occurrence due to excessive digital school work. However, time passed, and my pains persisted. The discomfort got to the point where I could not sit in a moving vehicle without tilting my neck an abnormal amount to rest it on a nearby headrest. Additionally, the sensation of needing to crack my neck was always apparent. Even during times of relaxation, when my neck and upper back were not as sore, the need to crack was always there.

After about a year, my mom began to pick up signs that something abnormal was going on. My neck cracking wasn't just a normal slow tilt of the head attempting to hear a pop. Instead it was a sudden, violent jerk of the neck. As a result, I booked in with a chiropractor to see if there was anything wrong with my alignment. The chiropractor felt that there was a slight misalignment in my upper back. However, when I went for an x-ray, there were no signs of scoliosis and my spine was presumed to be healthy. The chiropractor gave me a few exercises to do and I went on with my life.

A couple months later, after consistently doing the exercises, nothing seemed to change. I then tried physiotherapy for a few more months and nothing changed again. However, I did learn that after massages or nice warm showers, the soreness went away temporarily. This gave me hope and ignited my passion for trying to root out the cause myself. Rather than searching for another treatment, I decided to understand how my own body responds to different daily habits, activities, and interventions, and whether these findings can later help other teenagers experiencing similar technology related discomforts.

What it actually feels like

Here is a list of all my symptoms before the project. If you are reading this because something in your own neck feels wrong, some of it might sound familiar.

1. Neck discomfort, with a constant feeling of needing to crack it.
2. Upper back soreness, and a feeling of needing to pull my shoulders back all the time.
3. Forward head position.
4. Inability to tell whether or not my own body was straight.
5. Instability and weakness in the upper body region after prolonged screen time.
6. Neck muscle soreness.
7. Upper back and neck soreness after waking up. Sleeping on my side causes more soreness, and sleeping flat on my back causes soreness if I stay in the same position for a long period of time.
8. Uneven shoulders.
9. A movable spot on the left side of my cervical spine at around C2 to C3. When I press on it, it shifts and makes a slight popping sound, while the rest of my neck feels firm. This is the area my pain and urge to crack come from. See the T3 section of this website.
10. Discomfort sitting in chairs that are too straight, like plane seats, car seats and school seats. The headrest feels as if it is pushing my head forward. I am only comfortable when slouching, which causes discomfort as well.

What I noticed before I started tracking

• My discomfort decreased temporarily after taking warm showers and after exercising.
• As expected, discomfort occurred less when iPhone usage and time spent sitting down decreased.
• A masseuse noted that there was a muscle imbalance in my back. One side protruded more than the other and was tenser.
• When lying down and holding an iPhone, my neck and upper body discomfort was the greatest, even though my neck rested flat on the ground. That one did not make sense to me at first, and it became one of the questions I wanted to answer.
• Bad posture and any soreness in the upper back or neck made riding in cars or planes extremely uncomfortable, and it often caused headaches.

My medical history

Before any of the tracking started, I had already been through the normal route. I am including it here because it shaped how I designed the experiment. These are the things I already know do not work for me, so there was no point spending weeks testing them again. 

Two things stood out to me here. First, since the x-ray came back clean, whatever is going on is probably not structural. Second, the passive treatments where someone else moves or presses on me (ex. massage and chiropractic therapy) only provided short-term relief. As a result, I decided to use active interventions instead. These are interventions that I consistently do myself in order to change how I load my neck throughout the day.

How much load a forward head actually creates

The human head weighs around 10 to 12 pounds. When it is positioned directly above the shoulders, the weight is supported by the cervical spine efficiently and with little muscular effort. However, the pressure on the spine increases significantly for every inch that the head shifts forward relative to the shoulders [2].

Data adapted from Hansraj [2].

Depending on the amount of pressure generated by the position of the head, the muscles of the neck and upper back are required to generate a much greater force to support it. If this goes on long enough, that extra force causes muscle fatigue, discomfort, and soreness.

The four muscle groups that hold your head up

There are four main muscle groups that maintain proper head posture and shoulder alignment [3].

1  Deep neck flexors (longus colli and longus capitis)

• Their main role is to stabilize the cervical spine and maintain proper head position over the shoulders.
• These muscles tend to show a decrease in endurance and function in people with forward head posture. They are what chin tucks are meant to train.

2  Neck extensors (suboccipital muscles and cervical extensors)

• People with forward head posture often have overworked neck extensors.
• The sensation of always wanting to crack your neck comes from the soreness and stiffness of this muscle group. Tight extensors make the small facet joints in the neck feel stiff, which creates the sensation of needing to crack it.

3  Scapular stabilizers (middle and lower trapezius, serratus anterior)

• Their role is to stabilize shoulder movement when sitting or during upper body movement.
• When these muscles fatigue they let the shoulders round forward, which increases the strain on the upper back and neck.

4  The thoracic spine

• Located directly under the cervical spine.
• Increased thoracic kyphosis, which is when the spine curves out more than it should, can force the cervical spine to compensate and move forward. This leads to forward head posture from below.
• Increased thoracic kyphosis and neck flexion can also lead to painful shoulders and shortening of the anterior shoulder muscles, the pectoralis major and minor.

Where everything is, and where mine hurts

It became a lot easier to describe my symptoms once I knew the names of the parts. These are the regions and muscles this project keeps coming back to.

Where my discomfort is

• Cervical spine (C1 to C7): discomfort felt on the left side, around C2 to C5. The C2 to C3 area on that side is also the movable spot described in T3.
• Thoracic spine (T1 to T12): discomfort felt in the T3/T4 region along the left side. It feels dislodged, or slightly off center at that region.
• Scapulae: the left side sits differently from the right, and the muscle over it is thicker and stiffer.
• Facet joints: these guide neck bending, extension and rotation. They are the joints that feel stiff when the urge to crack shows up.
• Intervertebral discs: they provide cushioning between most vertebrae.

The muscles this project keeps coming back to

Four things that didn't make sense until I looked them up

Why my neck and upper back hurt while lying on my back with a phone

This was the one that confused me the most. My head is fully supported by the bed, so why is this the worst position out of all of them?

It turns out the head is not the only thing being held up. When holding a phone above the face, the arms require stabilization from the shoulder and upper back muscles, and the neck muscles are needed to continuously support the head and maintain visual alignment with the screen. Even though my neck is supported by the bed, these muscles remain active. If they stay active for an extended period of time, it leads to fatigue and soreness [4].

Why prolonged sitting causes neck muscle fatigue, and why standing or walking feels better

While sitting down, the muscles of the upper back and neck need to maintain a low level contraction in order to keep the head upright. Since sitting is often static, those muscles remain active over long periods of time, which causes muscle fatigue, soreness, stiffness and ultimately discomfort.

However, while standing or walking, the body makes slight postural adjustments that allow different muscles to be engaged. The load is spread out among multiple muscles that are constantly engaging and disengaging [5]. Therefore, I decided to add movement breaks into my intervention plans, and it also explains why my soreness is the lowest after excercise and outdoor time.

Why car headrests cause me extreme discomfort

The design of modern headrests focuses primarily on safety. They are designed to reduce whiplash injuries during rear end collisions, and as a result many of them are angled slightly forward [6]. If someone is already experiencing forward head posture as well as fatigue and stiffness in the neck and upper back, the headrest can feel as though it is pushing the head farther forward, causing discomfort. 

Why my back muscles are uneven

Muscle imbalances occur when some muscles become tight and overactive while others become weak and underactive. These imbalances can disrupt spinal alignment. Poor posture is the most common cause of muscle imbalances in teens. Spending hours sitting, looking down at devices, or performing repetitive detrimental movements can create imbalances over time [8].

Chronic back pain is a result of the body compensating for weak muscles by overusing others. These compensations place excessive stress on joints, ligaments and muscles. Muscle imbalances can also decrease spinal stability, since weak core and postural muscles are unable to support the spine properly. This perfectly reflects what my massuese noticed about my back and with what I can feel myself, which is that the left side of my back is stiffer and more pronounced than my right.

The science behind warm showers

Heat was the one consistent piece of relief I had found before this project started. Understanding why it worked is what convinced me the problem was muscular rather than structural. It is also the reason why heat ended up being integrated into Intervention Plans #2 and #3. 

Throughout the day your muscles maintain a low level contraction (for keeping posture upright etc.), meaning that they are never fully relaxed. Factors such as stress and mental effort can also increase tension. However, when you step into a warm shower, your body gets a signal to ease off [7]:

• Blood flow. When your skin senses the heat, your blood vessels dilate, which increases blood circulation and oxygen delivery. This allows your muscles to loosen.
• Nervous system. Warm sensations activate the safety and comfort nerve pathways in your body, which decreases tightening and lowers tension.
• Flexibility. Muscle fibres are partly elastic, so heat makes them more pliable and they resist movement less when warmed.

You may also notice that warm water feels more relaxing than warm air. This is because water covers the body evenly, transfers heat more efficiently, and stimulates skin receptors continuously. That constant stimulation of the sensory receptors is what keeps the relaxation signal going.

Sleep position

Sleep ended up mattering more than I expected. A lot of my worst mornings in the log line up with notes about sleeping on my side or on my stomach. Below are some sleep positions that either caused me higher or lower discomfort after waking up.

How I tracked it

The idea behind the design is simple. Change one thing at a time, keep measuring the same way every day, and write down everything else that could be confusing the picture.

The design

I tracked my discomfort on a 0 to 10 scale every day, where 0 means no discomfort and 10 means the worst I have experienced (Note: for certain variables, the scale is inverted). I started with a baseline where I changed nothing, and then introduced the interventions in blocks, with each plan building on the one before it.

Why I measured multiple times a day

Rather than recording symptoms only once per day, I took measurements at multiple points throughout the day, because my neck and upper back discomfort fluctuates a lot depending on the activity. The times were chosen based on routine study times and exercise/outdoor times.

What I recorded

Tracked variables (0 to 10)

• Neck soreness
• Upper back soreness
• Urge to crack neck
• Self awareness of body posture (scale inverted: higher means a better sense of whether I am straight)
• Discomfort sitting in chairs
• Stability (scale inverted: higher means more stable and more able to hold my neck upright)
• Head position (recorded as text on a four level scale: neutral, neutral/slightly forward, slightly forward, forward)

Check in points, days 1 to 57 (summer schedule)

• After waking up  ·  After shower  ·  After morning study (11am)
• After exercise (1pm)  ·  After afternoon study (5pm)
• After outdoor time  ·  After any phone use

Check in points, day 58 onward (school weekdays)

Once school started, my day stopped being built around study blocks I chose myself, so the check in points had to change with it. Weekends still use the summer schedule above.

• After waking up (time varies)  ·  After shower (time varies)
• After first period (1h 30 min)  ·  After second period (1h 30 min)  ·  After third period (1h 30 min)
• After lunch break (45 min)
• After any phone use  ·  After any evening study time

My periods shift around every day, so the times vary. I recorded them by what had just happened rather than by the clock, which is the same principle I used over the summer. The one genuinely new check in is after evening study, since that is now the only study block I control.

Confounders recorded alongside

• Sleep: deep, REM, light, awake and total, plus my own quality rating (Garmin watch)
• Shower: duration and quality
• Screen time: computer and iPhone, logged separately. The iPhone figures come from Screen Time in iPhone settings and the computer figures come from my computer's own screen time settings, so both are the device's own totals rather than anything I timed myself
• Exercise: type and duration
• Stress: Garmin's 0 to 100 daily score
• Notes: free text for anything unusual that day

The phases

Data collection is complete through Day 68. Days 1 to 57 cover the summer, and days 58 to 68 are the first two weeks of school.

A measure I still want to add

Everything above is subjective. The objective measure I planned and have not started yet is craniovertebral angle, which is the standard clinical way of quantifying forward head posture using a standardized side profile photo. Adding it would give the project an external check that does not depend on how I feel that day, and it is the first thing I would tell anyone copying this method to include from Day 1.

The three plans

Each plan keeps everything from the plan before it and adds another layer on top. The exercises are based on evidence based corrective exercise for forward head posture in adolescents [13].

Why cracking your neck makes you want to crack it again

Throughout the past 3 yearrs, this is the symptom that bothered me the most, and the one I understood the least. Here is what I worked out.

I found that my tension and stiffness normally occurs in the splenius capitis and semispinalis capitis, and that the urge to crack is usually in the C2, C3 and C4 regions of the cervical vertebrae. Tightness there is part of the story. But tightness alone did not explain why the urge never went away, even on days when the soreness did.

Further research suggested that a constant urge to crack your neck is most likely caused by a past trauma where a joint in the neck was dislodged. When you tear the soft tissue surrounding the joint, the muscles get locked and the joint does not move the way it should. That combination of a lack of motion and tightness of muscle is what gives you the urge to crack.

Corrective measures, or what I do instead

The idea from the habit research is that suppressing an urge rarely works, but replacing it with something that gives you a similar sense of relief does. So the rule is not to stop cracking. It is that when the urge comes, I do this instead.

1. Bring the chin down and let the head fall so I feel a stretch, then lean it to either side. This naturally stretches the tight muscles.
2. Light neck rolls.
3. Clasp my fingers behind my neck, push into my neck and squeeze into the clasp. While continuing to squeeze those muscles, bring the chin into the chest. You should feel the deep muscles release. Hold for about 30 seconds.
4. Chin tucks and shoulder blade squeezes done together.
5. Use a warmer during study sessions.

So far I have only been addressing the muscular and postural sides of this experiment. The structural joint part is not something I am able to assess on my own. I would need another x-ray or chiropractic review. Therefore, if my results show that my urge drops but never reaching zero, then that is the explanation for why.

What I can feel at C2 and C3

Partway through this project I noticed something specific. When I press on the left side of my cervical spine around C2 and C3, it seems to be slightly moovable or loose. The rest of my neck feels firm. It isn't drastic but it does shift, making a slight cracking or popping sound while doing so. Additionally, this areas causes the most neck pain and the strongest urget to crack.

Based on the cycle described above, this would be the hypermobile segment, and the firm areas around it would be the hypomobile ones compensating for it. That would also explain why the urge concentrates in the C2 to C4 region, and why it is on the left side, which is the same side as my uneven back muscles and my T3/T4 discomfort.

Overall, strengthening is the main conservative approach for a segment that moves too much. That includes excercises such as chin tucks, deep neck flexor work and scapular strengthening. These excercises matter more than stretching as aggressively stretching areas around a hypermobile segment is not apparently helpful. 

The 21 day rule is a myth, and I am using it anyway

A popular idea suggests that it takes around 21 days to solidify a habit. However, research done by Colin Camerer, a behavioral economist at Caltech, has shown that by January 2nd only 9% of people actually stuck to their goals in 2023 [9]. If 21 days were a real rule, that number would look very different.

What the research actually says is that the time varies a lot per individual, and that the key thing is repetition and consistency. So for my experiment I am using 21 days as a placeholder rather than a finish line. I am continuing Intervention Plan #3 for an extra 2 weeks for a total of 21 days, and if my goal isn't reached by then, I will keep doing these activities until it becomes a habit.

What I am applying

• Create a structured schedule, but avoid making it so rigid that missing one task feels like failure. The schedule should be realistic and flexible, since no one can follow an ideal routine perfectly every day.
• Try not to miss days. One missed day can create a domino effect in which the habit of skipping continues.
• Replace the habit instead of suppressing it. In a case like mine, where I have been cracking my neck for over 3 years, breaking the habit may be extra hard. My brain has already associated a reward system with it, which makes it incredibly difficult to reverse. Research suggests that simply forcing yourself to suppress a habit — such as resisting the urge to crack your neck — is often ineffective in the long term. A better approach is to replace it with a safer alternative that provides a similar sense of relief (see T3 for the corrective measures).
• Give the reward during the task, not after it. Research has also shown that rewards are great motivators only when they are given immediately. For example, someone could watch newly released movies while running on a treadmill instead of waiting until the end of the week. My version is listening to a favourite song or playlist during every stretch, break, walk and exercise, which started on Day 34.

Phone use is my worst variable

Whenever I am using my phone I always get very bad upper back and neck pain. Across all six of my numeric variables, the check in after phone use is the worst reading of my day. It is the clearest pattern in my whole log, and it is why phone rules show up in all three intervention plans.

Part of it is the angle. Part of it is that I often end up in weird and unnatural positions while using my phone without noticing, which is likely a factor in my chronic neck and upper back discomfort. And part of it is duration, because it is very easy to hold one position for forty minutes on a phone in a way you never would at a desk.

There is also more to it than posture. Phone addiction can lead to blurry vision, fatigue, worsened performance and loss of interest in other activities. Smartphones are very addictive and they encourage habitual and problematic patterns, so reducing unnecessary use helps with more than just my neck.

The rules I added on Day 33

• Not while eating, because this can create a dopamine dependence.
• Not for 2 hours before sleep, because this can negatively impact sleep quality in adolescents, specifically deep sleep [14]. Since my sleep stages are one of my tracked confounders, this one is directly measurable.
• Not for 2 hours after waking up, because of the same dopamine dependence, and because it is how I end up lying in bed on my phone, which is my worst position of all.
• Not while studying, because it becomes a habit that impacts work performance and promotes procrastination.

Every number I recorded

All of it, exactly as it sits in my spreadsheet, gaps included. If you want to check my reasoning, or run your own analysis on it, it is yours.

Photos from the start and the end

This is an outside check. The photos were taken at the beginning of the study and at the end of the study.

Both photos were taken in a relaxed posture rather than a corrected one, so this is how I stand when I am not thinking about it. The improvement is significant, but my posture is not perfect yet.

Results

Here are all my calculated results based on the data collected in the table above (T6). The analysis and interpretation of these results are in T9.

Table 1. Mean score in each phase

Each cell is the average of every reading taken in that phase. Scores run 0 to 10. On the two rows marked with a star a higher number is better; on every other row a lower number is better.

Table 2. Baseline against the last 14 days

Here is a comparison between the baseline data (control group) with the final 14 days of this study. The final column expresses the change in units of my own baseline day-to-day variation, so a value of 5 means the change is five times the size of my normal day-to-day variation.

Table 3. How much I varied from day to day

Standard deviation of the daily averages inside each phase.  Small numbers mean steady days, whereas large numbers mean swings. The baseline column is what Table 2 uses for the "change in standard deviation units" column.

Table 4. Which point in the day was worst

Average at each check in point, comparing the baseline with the last 14 days. The school check in points only exist in the second window, so those rows have no baseline to compare against.

Neck soreness

Upper back soreness

Urge to crack neck

Chair discomfort

Table 5. Head position

Head position was recorded as text, so I created a scale for each level: neutral = 0, neutral/s.f = 1, forward/s.f = 2, forward = 3. Every reading is shown, so each row adds up to 100%. The mean code is the average of those numbers, and the last column is how many readings each phase is based on.

Table 6. When each variable stabilized

The level each score settled at is the average of my last 14 days. A score counts as stabilized if it lands within its nomal day-to-day variation of that level, as calculated in Table 3. Additionally, the variable must maintain within those bounds for at least 5 days in order for it to count as stabilized. The days shown are the first of the five day steak.