This image has been doing the rounds on social media the last week or so. And I see that a lot of people are worried or just straight-up scared about the situation. This fear is mostly the result of journalism, rather than the science, so I’d like to take it all a step back and go through and share with you the science of this finding, what it means and also what it doesn’t mean.
The original science article that is being referenced in the majority of blogs is here, which was first published in 2016, so we’re already a bit behind the game here.
Let’s first critically analyze the science. This article is a retrospective analysis of existing patients in the office of one physician. The group has not been randomly selected, and therefore it is not representative of the general public. This means that it’s a little bit irresponsible to take the results of this review and extrapolate them to the general public. They did however, do a better study a couple of years later with a better sample (article here) – more on this shortly.
Clarification note: Many of the articles written by journalists refer to this as the “external occipital protuberance”, however, we all have one of those. What is being examined in the scientific papers is the enlargement of that protuberance.
First, let’s evaluate assumptions.
We kind of expect assumptions, embellishments and manipulation of facts from journalists for a good headline, but even in the 2016 scientific paper, the authors also made a number of assumptions that were not really validated, including:
- • these changes are bad, even though they report that an enlarged external occipital protuberance was asymptomatic (both in the current investigation and also with an aged population).
- • these changes are the result of smartphone devices; however there’s actually zero investigation into this within the study (nor does this address the huge differences seen between men and women).
- • that this was worse in these young adults than the elderly (but there was no actual statistical comparison done).
Thankfully they improved upon this work in 2018.
They got a reasonable sample size that spans many age-groups which allows them to use the data to speak to a comparison between ages. They also got a representative sample of the general population rather than an existing clinical cohort, which means that these findings may be extrapolated to the wider population, with caution.
With this comparison of age, they did indeed see age-related differences as well as sex differences. Interestingly they report that males are 5.48 times more likely to develop this enlargement, however they also report the following graph which seemingly contrasts that statistic:
I was also unable to source the actual data, so I can’t see how they got those figures. For now I’ll just say it seems a little unclear as to how males could have a 5.48x greater likelihood of this formation on the skill, but this graph represents that females have a higher prevalence in the 18-29 age bracket, with males only having a greater prevalence in the 40’s age-group.
In this second study, the hypothesis of causation is expanded from “hand-held technologies” to “sustained poor posture”, however this also seems to be odd, given that the graph representing posture doesn’t follow the same prevalence curve at all:
So what does this all mean?
Well, for starters it means a lot more research needs to be done. Given the figures above, we cannot accept that hand-held devices or even sustained poor posture in general are the causes of this enlargement of the external occipital protuberance. Neither one of those assumptions matches the data, and nor do they address sex differences.
This doesn’t mean we can rule them out as contributing factors, however they are clearly not the only ones at play here. Perhaps we should be looking at different markers of posture instead of just head-forward position, or perhaps examining the type of devices used, or the time spent in stillness using a device vs. simply the time spent on a device. There are many elements within those areas that still need to be examined, and then there’s a whole ocean of other variables that could also be contributing, such as sporting levels and types, any number of dietary influences, massage frequency, pillow type/use, and so on.
On top of that…
We need to keep in mind:
- • that adaptation often serves us as a species (not always, but more often than not).
- • that a huge percentage of these people were asymptomatic (which means they are not in pain, and it didn’t change how they live there lives at all).
- • most enthesophytes [read: bone spurs] are really thin layers of calcification around the tendon rather than solid bone, which isn’t a “down-play” of the situation, however it is a bit of a different image than “the skull is changing shape”. One is much scarier than the other, and pain often results from our fears.
So all in all, it’s sort of much ado about nothing. At least at the moment. Until there’s evidence to show that this enlargement of the external occipital protuberance is dangerous or bad of our health, we should just keep a watchful eye on how this understanding evolves. I understand that the article wouldn’t have had as many views if that were their headline – so it’s up to us to put our critical goggles on and evaluate the situation.
Should we all reduce our time on devices (computers, phones, tv’s gaming consoles)? Yeah probably. But don’t do it just because you think you’ll get a reverse unicorn horn if you keep your usage the same… do it for the plethora of other health benefit available from doing other things (like moving our bodies – which has a really great amount of evidence to suggest it’s good for us).