Update 6/25: After publication of this story, concerns were raised about an undisclosed business venture of one of the researchers, who works as a chiropractor. This story has been updated to reflect questions about a possible conflict of interest involving his business. The journal that published the main study in question said it was investigating the concerns. The researchers say they are making minor changes to their paper, but stand by their work.
Mobile technology has transformed the way we live — how we read, work, communicate, shop and date.
But we already know this.
What we have not yet grasped is the way the tiny machines in front of us may be remolding our skeletons, possibly altering not just the behaviors we exhibit but the bodies we inhabit.
New research in biomechanics suggests that young people are developing hornlike spikes at the back of their skulls — bone spurs caused by the forward tilt of the head, which shifts weight from the spine to the muscles at the back of the head, causing bone growth in the connecting tendons and ligaments. The weight transfer that causes the buildup can be compared to the way the skin thickens into a callus as a response to pressure or abrasion.
The result is a hook or hornlike feature jutting out from the skull, just above the neck.
A pair of researchers at the University of the Sunshine Coast in Queensland, Australia, has advanced the idea in several peer-reviewed journals that the prevalence of the bone growth in younger adults, which they have observed in X-rays, reflects distorted posture. The cause, they hypothesize, is prolonged use of smartphones and other handheld devices, which require users to bend their heads forward to make sense of what’s happening on the miniature screens.
Michael Nitabach, a professor of physiology, genetics and neuroscience at Yale University, was unconvinced by the findings.
“Without knowing about the cellphone use of any of the people whose head X-rays were analyzed, it is impossible to draw conclusions about correlation between cellphone use and skull morphology,” he said.
The researchers behind the striking claims are David Shahar, a chiropractor who recently completed a PhD in biomechanics at Sunshine Coast, and his supervisor, Mark Sayers, an associate professor of biomechanics at Sunshine Coast who has more than 60 peer-reviewed publications in academic journals.
Shahar, who runs a clinical practice on the coast of Queensland, near Brisbane, is also the owner of Dr Posture, an online store recommending strategies to improve posture, including the use of his Thoracic Pillow. He said he has “not engaged in selling of the product for a few years,” during the time when he was publishing in related fields.
Experts interviewed by The Washington Post said they found that decision problematic.
“It’s beyond any debate that other scientists and the public and legislators and journalists ought to know whether or not there are any competing interests for people who are working in an area where they are professing to be independent,” said Simon Chapman, an emeritus professor of public health at the University of Sydney and an editor of the peer-reviewed Tobacco Control journal for 17 years.
Shahar maintained there was no conflict because he had not recommended a particular course of treatment in the research but rather advanced a more general theory about the need to improve posture.
Scientific Reports declined to make an editor available for comment, offering a statement from a spokesperson that the journal was “looking into issues” with the paper and would “take action where appropriate.”
“Should we become aware of undisclosed competing interests not compliant with our policies, we will look into the matter carefully and update the literature when appropriate to ensure the scientific record is correct,” the spokesperson added.
If a further need emerges to state a conflict of interest, said the co-author, Sayers, “I’m happy to put my hand up and say that’s potentially a mistake.”
He added: “It’s not been my experience of seeing it done, but the reality is that David is a chiropractor.” Sayers said he remained “confident” in the data, which has been “freely available in the research bank of our university.”
For a different study published this year, assessing the effectiveness of a device designed to relieve pressure on the spine, Shahar did disclose a possible conflict. The paper, which appears in the peer-reviewed Spine Journal, states that the author “is the developer of the Thoracic Pillow.”
According to specialists in research ethics, the distinction between testing a specific product and suggesting a more general intervention is less significant than it might seem.
In a 2012 review, Chapman found an across-the-board failure by Australian universities to hold academic staff accountable for compliance with standards for declaring competing interests. The problem is just as acute, he said, for academic journals, few of which have the resources to independently investigate possible conflicts.
Standing to gain from one’s research does not necessarily discredit it, said Nancy Berlinger, a research scholar at the Hastings Center, a bioethics research institute in New York.
“Plenty of clinician investigators are, for instance, working on a patent,” she said. Disclosure allows the academic community and the public at large to decide whether the presentation is still trustworthy, she said.
Brian Earp, the associate director of the Yale-Hastings Program in Ethics and Health Policy, said readers may want to apply “heightened care in evaluating the methods of the research” if they know an author has a vested interest in the availability of evidence for a certain conclusion.
The research published in Scientific Reports, which gained widespread attention following coverage last week in The Post, was subject to significant criticism. Skepticism centered on the source and size of the sample and the ability to draw conclusions about the use of smartphones from X-ray evidence, some of which was drawn from patients experiencing mild neck problems.
John Hawks, a biological anthropologist at the University of Wisconsin at Madison, offered other explanations for the bone growth at the back of the skull and argued that the protrusions were actually minimal. Shahar said an outgrowth was only factored into their research if it measured 10 millimeters, or about two-fifths of an inch.
Although the study came out last year, it first drew fresh notice following the recent publication of a BBC story that considers, “How modern life is transforming the human skeleton.” The unusual formations captured the attention of Australian media, and have variously been dubbed “head horns” or “phone bones” or “spikes” or “weird bumps.” Each is a fitting description, Shahar said.
“That is up to anyone’s imagination,” he said. “You may say it looks like a bird’s beak, a horn, a hook.”
Much of the interest generated by the study focused on the use of the term “horns,” causing Shahar to clarify that he used the term in interviews as an analogy, a way of understanding what the formations look like. He argued that structures and conditions are often named because of how they appear, rather than what they chemically represent. He cited Occipital horn syndrome, a connective tissue disorder, as an example.
The researchers said their discovery marks the first documentation of a physiological or skeletal adaptation to the penetration of advanced technology into everyday life.
Health experts warn of “text neck,” and doctors have begun treating “texting thumb,” which is not a clearly defined condition but bears resemblance to carpal tunnel syndrome. But prior research has not linked phone use to bone-deep changes in the body.
Their work began about three years ago with a pile of neck X-rays taken in Queensland, some at Shahar’s own clinic. The images captured part of the skull, including the area where the bony projections, called enthesophytes, form at the back of the head.
Contrary to conventional understanding of the hornlike structures, which have been thought to crop up rarely and mainly among older people suffering from prolonged strain, Shahar noticed that they appeared prominently on X-rays of younger subjects, including those who were showing no obvious symptoms.
The pair’s first paper, published in the Journal of Anatomy in 2016, enlisted a sample of 218 X-rays, of subjects ages 18 to 30, to suggest that the bone growth could be observed in 41 percent of young adults, much more than previously thought. The feature was more prevalent among men than among women.
The effect — known as enlarged external occipital protuberance — used to be so uncommon, Sayers said, that one of its early observers, toward the end of the 19th century, objected to its title, arguing that there was no real protrusion.
That’s no longer the case, according to the researchers.
Another paper, published in Clinical Biomechanics in the spring of 2018, used a case study involving four teenagers to argue that the head horns were not caused by genetic factors or inflammation, pointing instead to the mechanical load on muscles in the skull and neck.
And the Scientific Reports paper, published the month before, zoomed out to consider a sample of 1,200 X-rays of subjects in Queensland, ages 18 to 86. The researchers found that the size of the bone growth, present in 33 percent of the population, actually decreased with age. That discovery was in stark contrast to existing scientific understanding, which had long held that the slow, degenerative process occurred with aging.
The danger is not the bone spur itself, Sayers noted. Rather, the formation is a “portent of something nasty going on elsewhere, a sign that the head and neck are not in the proper configuration. "
“These formations take a long time to develop, so that means that those individuals who suffer from them probably have been stressing that area since early childhood,” Shahar explained.
To understand what was driving the effect, they looked to recent developments — circumstances over the past 10 or 20 years altering how young people hold their bodies.
The sort of strain required for bone to infiltrate the tendon pointed him to handheld devices that bring the head forward and down, requiring the use of muscles at the back of the skull to prevent the head from falling to the chest. “What happens with technology?” Shahar said. “People are more sedentary; they put their head forward, to look at their devices. That requires an adaptive process to spread the load.”
That the bone growth develops over a long period of time suggests that sustained improvement in posture can arrest it and prevent its associated effects, the authors said.
Sayers said the answer is not necessarily swearing off technology. There are less drastic interventions.
“What we need are coping mechanisms that reflect how important technology has become in our lives,” he said.
Shahar, in his work as a chiropractor, is pressing people to become as regimented about posture as they became about dental hygiene in the 1970s, when personal care came to involve brushing and flossing every day. Schools should teach simple posture strategies, he said. Everyone who uses technology during the day should get used to recalibrating their posture at night.
As motivation, he suggested reaching a hand around to the lower rear of the skull. Those who have the hornlike feature can probably feel it.