Young Mobile Phone Users Developing Bony Protrusions as a Result of Overuse?

In an article, published in The Guardian last Friday, Gideon Meyerowitz-Katz, an epidemiologist in the field of chronic disease, dissected an accusation that disproportionate mobile phone usage is causing younger users to develop abnormal ‘“hornlike” protrusions at the base of their skulls’, called external occipital protuberances (EOP).[i]

This allegation is founded in a study, circulated in the Scientific Reports journal and cited in a BBC Future article,[ii] which found that EOP were most enlarged in 18 to 30-year-olds.[iii]

Our recent article on occupational plantar fasciitis (here) made reference to heel spurs, or to use the proper scientific term, osteophytes, which can form at the calcaneal tuberosity (the posterior extremity of the heel bone). EOP are a different type of bony spur, called enthesophytes, which may form where tendons and ligaments meet the occipital bone.

Figure: Occipital Spur


(Source: Wikimedia Commons - Edited by BC Legal)

The latest study, which follows up on a past study[iv] by the same authors, observed a large selection of X-rays pertaining to a group of 1,200 18 to 86-year-olds. Visible EOP were classified as ‘normal’ or ‘enlarged’, on the basis that ‘enlarged’ EOP (EEOP), between 10 and 30mm in length, could be associated with trauma or other health issues.

Prevalence of EEOP was compared by age category (18–30, 31–40, 41–50, 51–60, >61). This revealed that in 18 to 30-year-olds, who were most likely to display EEOP, incidence was 7% higher (40%) than in the general population (33%). EEOP were also 5.48 times more common in men than in women.

In the same way that heel spurs are a symptom of inflamed plantar fascia, researchers at the University of the Sunshine Coast, Australia, considered that EEOP growth is a symptom of painful musculoskeletal strain, particularly contortion of the spine. 

From this, it was hypothesised that EEOP may be linked with ‘sustained aberrant postures associated with the emergence and extensive use of hand-held contemporary technologies, such as smartphones and tablets’.

Lead author, Dr. David Shahar, explained that the motion of shifting the head forwards to look at smartphones, relieving spinal pressure for sustained periods, is a significant weight transfer for the neck and back to continuously mitigate – the average head weighs around 4.5 kg:

‘The increased load prompts remodelling on both the tendon and the bony ends of the attachment. The tendon's footprint on the bone becomes wider to distribute the load on a larger surface area of the bone’.

However, Meyerowitz-Katz contends that ‘the evidence isn’t nearly as clear as some [look at The Daily Mirror article[v] (here)] have said’, not least because the study did not measure mobile phone use. Their conclusions were based on a process of elimination, as can be inferred from the journal article ‘Discussion’:

‘... many activities involving these postures (e.g. bike riding using drop hand-bars, sleeping supine with a high pillow, etc.) have been prevalent for decades, and therefore cannot provide an explanation to the high prevalence of EEOP in our young adult population’.

As such, Meyerowitz-Katz deduced that:

‘It’s impossible to know from the information in the paper whether this modest increase in risk of enlarged EOP 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’.

In addition, Meyerowitz-Katz criticised the editors for failing to ensure that the article was free of errors and contradictions and therefore failed to maintain its credibility. How did the article pass the peer-review? Should it have even been published?

While evidence in support of technology-induced occipital spurs may be inclusive, the fact that young people are exhibiting an indicator of prolonged posture problems, which is a precursor to chronic long-term pain, is not a positive sign just one-decade into the so-called ‘tablet revolution’. It is more concerning when considered in combination with our report on ‘selfie wrist’, ‘iPhone hands’ and ‘text neck’ in last week’s edition of BC Disease News (here).

Moving forwards, Dr. Shahar recommends posture modification when using hand-held technologies.


[i] Gideon Meyerowitz-Katz, ‘Are young people growing horns because of mobile phones? Not so fast’ (21 June 2019 The Guardian) <> accessed 24 June 2019.

[ii] Zaria Gorvett, ‘How modern life is transforming the human skeleton’ (12 June 2019 BBC)> accessed 27 June 2019.

[iii] David Shahar & Mark G. L. Sayers, Prominent exostosis projecting from the occipital squama more substantial and prevalent in young adult than older age groups. Scientific Reports Volume 8, Article number: 3354 (2018) <> accessed 24 June 2019.

[iv] David Shahar & Mark G. L. Sayers, A morphological adaptation? The prevalence of enlarged external occipital protuberance in young adults. J. Anat. (2016)229, pp286—291. <> accessed 27 June 2019.

[v] Sophie Curtis, ‘Young people are 'growing HORNS on their skulls' due to excessive smartphone use’ (21 June 2019 The Mirror) <> accessed 24 June 2019.