Doctors discover plasticity! Shock horror!

Teenagers are acquiring bone abnormalities from cell phone use! It’s the perfect story, combining contempt for social media and technology and young people with an apparent appropriate comeuppance for those sins.

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 are 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 phenomenon is called an EEOP, or enlarged external occipital protuberance, and in a study of 1200 people, they found that about a third have this feature…and that it is more common in men and younger people. They assume from the differences in frequency at different ages that this is an emerging, recent change, which may be reasonable, but I’d like to see a better analysis of the causes.

The authors also assume that this is an undesirable change, with loaded language and an attempt to imply this feature causes serious problems.

Alarmingly, a survey of university staff and students revealed that participants spend an average of 4.65 hours/day using a hand held mobile device, and that 68% of the participating students reported neck pain.

Why is mobile device use alarming? Also note: they do not show a correlation between the presence of EEOPs and neck pain. We’re simply supposed to assume there’s a causal relationship, I guess, between exostoses and this vaguely defined term, “neck pain”. They have not shown that these bony bumps are a problem, but they are ready to raise the alarm.

Clearly, our findings should raise concern as morbidity and disability due to musculoskeletal disorders impose increasing physical, social and financial burdens on individuals and societies. Accordingly, the mitigation of poor postural habit through prevention intervention may be prudent.

Again, they have not demonstrated morbidity or disability. They’ve found that lots of people have these “bumps” that are easily detectable in x-rays, and maybe it’s because people are peering at their cell phones or playing the video games, so there must be a problem. They’ve only shown that the phenomenon exists!

To which I would point out the example used in the Washington Post article: hard work causes a healthy plastic response by your tissues, building up calluses. Are we alarmed by the growth of calluses in working people? Or do we recognize that this is a normal protective response by our bodies to environmental stresses? If you adopt an unusual posture in your work, your bones, cartilages, and tendons also mold themselves to fit.

They also show that 40% of college-age people are exhibiting this “problem”. I’d say that if it’s that common, while these same people seem to be functioning well and are actively and voluntarily engaging in the activity that putatively causes it, it probably isn’t a problem. It may also become the new normal. When over half the population expresses it, will doctors change their diagnoses and note of the new minority, “Oh, you’re missing your occipital exostosis. I’m going to recommend some physical therapy to build it up”?

Finally, one peculiarity here is that they’re jumping all over this possibly entirely benign phenomenon. Rather than focusing on college students using cell phones, I wonder what musculo-skeletal distortions are affecting people who are doing stoop labor, or other repetitive tasks in their work. Perhaps someone can put together an alarmist paper showing the plastic responses in the bones of menial laborers, expressing concern for the unfortunate spinal problems of those people. After all, if you’re horrified that students spend 5 hours a day looking at their phones, you should be experiencing raging apoplexy about farm workers spending 8-10 hours a day bent over, picking crops.

Nah, those people don’t matter.


  1. says

    See also the effect of shoes on foot morphology, or how diet affects jaw development and tooth growth. Raise the alarm!

  2. Dunc says

    I’ve spent my entire working time in the last 25 years sitting at a desk, driving a computer. I’m pretty sure it’s not been good for me.

  3. says

    I had a letter published in the second or third issue of OMNI, responding to an article on how mystified the fellows in the undergarments department of Sears were by the gradual shift in women’s measurements from being hourglass-shaped to something more cylindrical today. I suggested they look at their own products: No more whalebone, no more binding corsets. ‘Twas fashion did it.

  4. says

    The lead author of this paper is an Australian chiropractor, so it’s no surprise that they’re scaremongering about neck pain. I don’t know if this also holds true in America, but in Australia and here in New Zealand Chiropractors are rather notorious for trying to get more clients through unethical means, such as “free spinal testing” stands at events where they tell everyone they meet that they need to see a chiropractor.

  5. nomadiq says

    Thanks for this. I came across it on my social media feeds this morning and the usual uninformed and hysterical response. The misunderstanding of biology has been bugging me all day. I wonder how many bone spurs in unusual places were produced when modern-day millennial ancestors would spend hours harvesting wheat or digging up coal?

  6. PaulBC says

    I worry more about my son biking 3 miles each way with a 25 pound load of textbooks on his back.

  7. wzrd1 says

    It’s always interesting when the press discovers a study that fully deserves entry into The Journal of Irreproducible Results.
    Alas, not quite as entertaining as when said journal became a subject of interest in the oxymoron, military intelligence, when an article from said journal was found in an Al Qaeda headquarters on the subject of how to construct a nuclear warhead. Well, in that instance, it was mutually entertaining, the intelligence types and the journal personnel were quite mutually entertained.

    Still, given the state of the press these days, any half-baked article on repetitive stress would likely be reported as “Stress is bad for you”, ignoring the reality of gravity induces stress upon tissues that, when lacking gravitational results, results in muscle wasting, bone loss and hypotension when the astronaut/cosmonaut is reintroduced to gravity. Or worse, the article would then become titled, “Gravity is bad for humans”.

  8. garnetstar says

    Every ballet dancer, male and female, has to start when their bones are young and green, so they can mold their bones to adopt the turned-out-at-the hips posture that ballet requires. The heads of the dancers’ femurs and their placement in the hip sockets has to be permanently altered. The dancers tend to walk duck-footed for the rest of their lives. The horror.

  9. says

    Looks like I’m going to have to have hip surgery because of bone spurs. Probably because of 40 years of high impact dancing. They are effecting the range of motion of my hip joint. Hard to get socks on my left foot.

  10. gijoel says

    That sounds a lot like Phillip Zimbardo’s “porn is ruining young men, we must teach them how to dance.”

  11. kaleberg says

    How do they know its from staring at cell phones? One uses almost the same muscles to read a book.

  12. chigau (違う) says

    kaleberg #11
    It’s because they are full of shit.
    (but I know you were being rhetorical)

  13. microraptor says

    I remember in anthropology class how on medieval English graveyards how easy it was to tell the skeletons of bowmen from everyone else.

  14. vucodlak says

    @ PZ, #1
    When I was a child, one of the big themes with my parents was that I “don’t know what pain is, and I shouldn’t complain,” with the “unless I want learn” mostly left unspoken. One result is that I wore shoes long after they ceased to fit properly because complaining about my feet hurting was a good way to smacked.

    So, my toes are deformed. My middle toe is bent over my next-to-smallest toe, which is crooked and fat. My pinkie toes are even more crooked, twisted at an odd angle, and their middle joints don’t move at all. Unlike an upside-down headhorn,* this actually has negative consequences- my feet hurt if I walk any distance or spend much time on them, especially my pinkie toes.

    *Which I may well have, thanks to the countless hours I spent reading books. We didn’t have smartphones when I was a kid, and I never really got into to handheld gaming.

  15. chrislawson says

    The discussion part of the paper is the least of its problems. Check out the methodology:

    No description of how patients were recruited. As best we can tell, each X-ray was taken from the database of a chiropractor’s clinic. Which means it is already a skewed sample since it does not reflect the general population.

    Acknowledges that “some members of this sample had complaints associated with the cervical spine”, a clear potential confounder, but does not report on the proportion or the nature of those complaints.

    No blinding. The person who assessed the length of the osteoses was the same clinician who had referred the patients to X-ray.

    No independent check of the osteosis length. The author argues it was not necessary because a previous, much smaller trial he did with an independent check found “these data collection procedures having been shown to be both accurate and reliable.” So one previous test of reliability means all future studies can abandon them!

    “Patients that recorded symptomatic complaints greater than mild were excluded from this analysis.” Well OK, I can understand why they would exclude moderate-severely affected patients, but it also means the authors shouldn’t be suggesting any correlation between symptoms and osteosis length.

    “The use of radiographs of this mildly symptomatic population is not a limitation, given that the mean EEOP size for the asymptomatic population in our previous assessment (14 ± 7 mm) was significantly greater (P = 0.006) than that recorded for the mildly symptomatic population (12 ± 6 mm) in the same study.” Actually, it is still a limitation. Having a previous, more rounded study doesn’t magically prevent confounders creeping in if you change the exclusion criteria. Also, this previous finding (asymptomatic patients had longer exostoses) seems to contradict the current findings (asymptomatic patients had shorter exostoses). Why?

    “Importantly, it is acknowledged that the anatomical level of degeneration is frequently worse than the level of degeneration observed in radiographs.” Actually, of the 2 papers referred to here, one did not find that (its design could not find that since it only examined X-rays and did not dissect people to see how well their anatomy matched) and the other is an obscure paper from 1971 that has no abstract on PubMed doesn’t even turn up on my uni library searches, and the journal itself no longer hosts the paper on its website. Also, the first paper came to a very different conclusion than “OMG exostoses are even scarier than they look on X-ray!” What it actually reports is “It is important to realize that although roentgenographic abnormalities represent structural changes in the spine, they do not necessarily cause symptoms.”

    Finally, although the trial itself received ethics approval (which I agree with by the way; it was not an unethical trial), I question the ethics of a clinic having a repository of thousands of neck X-rays for people with no neck symptoms. Since the primary author is an Australian chiropractor, he would be aware that in 2017 the federal Health Department ruled that chiropractors could no longer bill Medicare for “whole spine X-rays” because it was costing the government a small fortune, did not lead to clinical benefits to the patients, and exposed huge numbers of people to unnecessary ionising radiation. No mention of that in the paper.

  16. sarah00 says

    Further to chrislawson’s points @16, the authors did nothing to quantify the phone/tablet usage of the study subjects. They have assumed that the bone spurs are correlated with their usage without having any data to test this.

  17. blf says

    I don’t know if this also holds true in America, but in Australia and here in New Zealand Chiropractors are rather notorious for trying to get more clients through unethical means

    That certainly used to be the case in the States, and I presume it still is.


    The Grauniad on the “study”, Are young people growing horns because of mobile phones? Not so fast:

    Mobile phones probably aren’t turning young people into literal demons from hell just yet


    Recent headlines have played into [unsubstantiated fears about mobile phones], announcing across the world that mobile phones aren’t just a great way to play Angry Birds on the train, they’re actually making young people grow “hornlike” protrusions at the base of their skulls. While many millennials would probably welcome devil horns — I mean, who wouldn’t — these are apparently the result of painful spinal contortions that are a major problem for human health.


    [… T]his research never measured phone use. It’s impossible to know from the information in the paper whether this modest increase in risk of enlarged EOP [external occipital protuberances] for young people had anything to do with mobile phones at all. Any connection to a cause of enlarged EOPs is total speculation, especially because even if the researchers had managed to get a measure of mobile phone usage for these people, the study design itself wasn’t rigorous enough to make a claim of that type. This study just showed that age was associated with the rate of EOPs, which is a far cry from showing that mobile phones were the root of the problem.

    The study also had some worrying problems. As a number of people on Twitter pointed out, the data in the study directly contradicted itself, showing in a graph that men had fewer enlarged EOPs than women but saying in the text that they had more. There were also a number of minor numerical errors — calling the young group 18–29s in one place and 18–30s in another — and a somewhat problematic method of sampling. In fact, the top comment on the paper in the online journal asks how it got through peer-review in the first place, implying that it probably shouldn’t have been published at all. While all of these errors may not be the fault of the authors — the journal editors might be to blame — it makes it much harder to trust the results as reported.


    Some of the readers’s comments (some minor Typos offerings corrected (not marked), and some minor reformatting (also not marked)):

    ● “It’s an evolutionary response to the involuntary butting contests, when they keep walking into each other with lowered heads”.

    ● “Probably caused by trauma. Walking into walls, lamp-posts etc whilst staring at your screen isn’t good for you!”

    ● “‘Mobile phones probably aren’t turning young people into literal demons from hell just yet’ — Yet many of them shuffle around like zombies.”

    ● “‘it probably shouldn’t have been published at all’ — Quite, because there’s rarely been a more clear-cut case of phoney research.”

  18. chrislawson says


    I wouldn’t call it “phony” research. I think label ought to be withheld for confirmed cases of research fraud. But it’s still very poor research. The sad thing is, this was published in a Nature journal — not Nature itself, but one of its saplings. And the editors will be delighted with the media attention it has received. This is what is has come to. Even our best scientific journal franchises are pumping out flotsam if they think it will drive citations and media attention.

    So much for the integrity of peer review (I find it difficult to believe any halfway-knowledgeable reviewer would have recommended this paper without major revisions).

  19. blf says

    chrislawson@19, I tend to concur, albeit I myself am not as strict about applying the label “phony” (which in this case, should perhaps be spelled “phoney”?). It was a reader who said that. My bigger problem with that reader’s comment is the assertion “there’s rarely been a more clear-cut case…”. Not so clear-cut, but certainly highly dubious and sloppily-reported, probably also sloppily conducted. Cargo cult research.

  20. snuffcurry says

    This is just scholar’s neck, an old phenomenon, dressed up to oblige some old-fashioned cloud-yelling about yoots. Would be it less scandalous for these people if we reminded them that life-long dedicated book-readers also get this?

  21. jrkrideau says

    @ 6 PaulBC

    I worry more about my son biking 3 miles each way with a 25 pound load of textbooks on his back.

    And well you should be. Riding like that may cause back problems in the long run but the more serious issue is safety. That weigh on his back, is raising his centre of gravity much higher than it should be and very probably making him unstable and liable for falls and crashes.

    If one is going to carry those weights one should have a proper set of panniers on a good stable rear rack.

    See for example Arkel pannier for what I mean. High end pannier like these should give your son about 40 litres storage (20 litre per bag)and allows him to balance the load properly.

    Note I use Alkel bags with great satisfaction and could pull up the link quickly but there are probably at least two or three others just as good. The German Ortlib comes to mind and they look very good and have the advantage of being waterproof. Both the Arkel and Ortlib are expensive but are very durable. Lower cost panniers are false economy.

    As a quick test I stuck 4 coffee table cook books (roughly 5 kilo)into one of my pannier and had close to half of the pannier space left so 25 lb of books should fit into two pannier easily and give him a fair bit of room for a few other things.

    While I cannot prove it, panniers should also reduce fatigue.

  22. Athaic says

    Bone spurs developed following an overuse of cell phone? Isn’t that is ailing a former TV celebrity currently living in some whitewashed house in Washington?

  23. DLC says

    Researchers discover that newspapers sometimes print bogus stories, especially when someone tells them It’s Science!