Pain Relief Center in Lima NY/Walt Fritz, PT

08/06/2026

https://www.facebook.com/share/p/1BWdyunyQW/

📱 “Text Neck” A real threat or more of a media arrative?

In recent years, the term “text neck” has become increasingly common in both the media and clinical practice. Many people believe that simply looking down at a smartphone for prolonged periods will inevitably lead to cervical degeneration or chronic neck pain.

However, the current scientific evidence suggests that the story is far more complex.

The concept of “text neck” is often oversimplified or overstated in public discussions. While looking down at a smartphone does increase the mechanical load on the cervical spine and surrounding muscles, there is currently no strong evidence demonstrating that this posture alone directly causes chronic neck pain. Neck pain is a multifactorial condition influenced by physical activity levels, sleep quality, psychological factors, duration of sustained postures, tissue load tolerance, and a wide range of interacting biological, psychological, and social factors.

🔍 What does the current evidence tell us?

✅ Damasceno et al. (2018)
In a cross-sectional study of 150 young adults (18–21 years), the authors found no association between “text neck” posture and either the presence or frequency of neck pain. Cervical posture was not an independent predictor of symptoms.

✅ Mingels et al. (2021)
A study involving more than 200 medical students found no significant relationship between smartphone use, neck flexion angle, and neck pain intensity.

✅ Minghelli et al. (2023)
A systematic review applying the Bradford Hill criteria concluded that there is currently insufficient evidence to establish a causal relationship between “text neck” and neck pain.

However, this does not mean that posture is irrelevant.

⚠️ Al-Hadidi et al. (2023)
Students who used smartphones for more than four hours per day were more likely to report neck pain. However, this finding represents an association rather than causation, and does not demonstrate that neck flexion itself is the direct cause of pain.

⚠️ El-Borgy et al. (2024)
Excessive smartphone use was associated with reduced endurance of the cervical extensor muscles and a greater forward head posture. These adaptations may influence the cervical spine’s capacity to tolerate load over time, but they do not establish that these postural changes directly cause neck pain.

💡 What can we learn from the evidence?

👉 There is no such thing as a “perfect posture.”
The cervical spine is designed to move in multiple directions, including flexion. Activities such as reading, writing, sewing, and smartphone use all involve similar neck positions.

👉 Load management matters more than posture alone.
Any posture even one considered “ideal” can become uncomfortable if maintained for prolonged periods.

👉 The spine is remarkably adaptable.
Claims that looking down at your phone will inevitably “damage” your neck or accelerate degeneration often go beyond what current scientific evidence supports.

👉 Physical activity, sleep quality, and overall health appear to be stronger contributors to neck pain than smartphone posture alone.

🎯 Clinical implications

Neck flexion during smartphone use or the presence of a forward head posture should not automatically be interpreted as the cause of neck pain, nor should they be viewed as the sole target of treatment.

Rather than telling patients, “Don’t look down at your phone because you’ll damage your neck,” clinicians may find it more helpful to explain that:

The cervical spine is designed to move and adapt to a wide variety of positions. Rather than striving for a “perfect posture,” the goal should be to avoid remaining in any one position for too long, vary movement regularly, stay physically active, improve muscular strength and endurance, maintain good sleep habits, and progressively build the body’s capacity to tolerate everyday loads.

Neck pain rarely results from a single cause. Therefore, assessment and management should be individualized and guided by a biopsychosocial model, rather than attributing symptoms solely to “text neck” or forward head posture.

Disclaimer:
👉 Sharing a study is NOT an endorsement.
👉 Always read the original research and interpret the findings critically.

07/25/2026

Manual therapy is typically seen as a "clinician-as-expert" intervention, one in which the therapist is tasked with determining the problem and the proper solution. Simple, right? But is it that simple?
I learned and practiced manual therapy/myofascial release in that form and had success applying it over the decades. At one point, however, I realized that my expertise led me to narrow my range of potential treatment choices, as those decisions were based on my internal world rather than the individual patient's. This realization allowed me to begin transitioning to a model that allows power sharing and elevates a patient's sense of expertise to a level often equal to mine. In this video, we look at a small slice of that process.
If this approach interests you, please look over the website for classes (in-person and online), podcasts, and other information. www.WaltFritz.com.
Follow for more.
https://youtu.be/2oSnRff6Xls

Manual therapy is typically seen as a "clinician-as-expert" interve...

05/29/2026

I have been repairing rotator cuffs for 30 years. And the most important thing I do in my office most days is talk people out of surgery they do not need.

Rotator cuff issues are omnipresent with age. Over 90% of people aged 40 or older have rotator cuff abnormalities on MRI. By your seventies, at least 30% have a full-thickness defect. Most of these people have no idea because the defect is not causing symptoms, and the shoulder still functions. So if you walk into an orthopedic office with shoulder pain and the MRI shows a "tear," that finding alone does not mean something happened or that something needs to be fixed.

Most cuff defects are not tears in the way you think. They are the result of decades of tendon attrition in a stress-shielded zone that gradually thins and develops a defect. It has more in common with the gray hair on your head than with a torn ligament from a sports injury. And the reason most of these defects do not compromise function is because of a structure called the rotator cable… a thick band of fibers that carries most of the mechanical load across the cuff like a suspension bridge.

The supraspinatus, the tendon most commonly reported as "torn," lies within the cable in a region that experiences very little force. If the cable and load path are intact, the shoulder continues to work just fine.

The evidence reflects this. The MOON Shoulder Group found that structured physical therapy was effective in approximately 75% of patients with atraumatic full-thickness rotator cuff tears at two years. Randomized trials show no clinically meaningful difference between surgery and PT at one year for degenerative tears. The default treatment for most atraumatic tears is non-surgical.

That is what the data says, and that is what I tell most patients in my office. I wrote a deep dive on this… how the cuff actually works, why the cable matters, when surgery is the right answer, and what to do if you have been told you have a tear and are not sure what comes next.

Read full article here:https://howardluksmd.substack.com/p/why-most-rotator-cuff-tears-dont

05/21/2026

"The Effect of Diagnostic Labels on Treatment Preferences and Beliefs in People With Musculoskeletal Pain. A Systematic Review of Randomized Trials"
I filed this one under "Catastrophizing". There is wide variability in categorizing musculoskeletal or similar disorders. Patients clamor for MRIs, etc., while the evidence often leans away from such testing. We now know that even pain-free individuals will demonstrate significant findings when imaged, often leading to nocebic or catastrophizing of symptoms. This systematic review found that diagnostic labels for musculoskeletal pain significantly influence patient treatment preferences, with structural, pathoanatomical terms (e.g., "disc bulge") increasing the demand for invasive interventions compared to non-specific, general terms. Labels focusing on structural damage often heighten concerns about condition severity and lower recovery expectations, whereas contextual explanations and non-specific labels tend to encourage more conservative care approaches.
I wonder if similar effects might be found when we label a problem something from our niche of training, for instance, "Your fascia is restricted, your trigger points are causing the issue, etc., or your weakness is the cause of your pain"?
The full-text paper is available from the link.

https://www.jospt.org/doi/10.2519/jospt.2025.13759?fbclid=IwY2xjawR8BZJleHRuA2FlbQIxMQBzcnRjBmFwcF9pZBAyMjIwMzkxNzg4MjAwODkyAAEeLvVl_CtIUVWf07r7D9kFipgP77f58MmQszySxtDMo5Rjf2qlCNYRkYDuY-0_aem_FiLugS2jWbN9lk4Kav814g

OBJECTIVE: To assess how different diagnostic labels affect treatment preferences and beliefs in people with musculoskeletal pain. DESIGN: Systematic review of randomized trials. LITERATURE SEARCH: PubMed, Web of Science, MEDLINE, CINAHL, SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the Australian...

05/05/2026

A worthwhile read. Moving beyond the "get stronger" narrative to help with pain. Thanks to Nick Ng for his article.
https://massagefitnessmag.com/fitness/researchers-challenges-get-stronger-message-in-pain-treatment/?fbclid=IwY2xjawRm8HdleHRuA2FlbQIxMABicmlkETFBM05qSmdreWVrdlhnQlhMc3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHh-27nq4oVd2OBzAlB2Kz2vCA6-wN5s--j8txL_1OJJTyCFRJwjiUHICD5ek_aem_kbnxvZkDToFURaUaC08dOQ

A 2025 editorial published in the British Journal of Sports Medicine argued that increasing muscular strength is not the main driver for reducing pain. Instead, they wrote that strength training is one component among several factors that contribute to pain reduction, based on the biopsychosocial fr...

02/28/2026

"Perception and lived experience of movement in patients
with fibromyalgia: a qualitative systematic review with meta-synthesis and meta-summary"
"Conclusion For individuals with fibromyalgia, movement is experienced as both beneficial and risky. Patient-centered
rehabilitation could validate pacing, formalize existing self-management strategies, and offer tailored, supported pathways
to sustainable activity."

For individuals with fibromyalgia, movement is experienced as both beneficial and risky. Patient-centered rehabilitation could validate pacing, formalize existing self-management strategies, and offer tailored, supported pathways to sustainable activity.

02/24/2026

"What do we mean by partnership in making decisions
about treatment?"
An older, but brilliant look at shared decision-making.
My entire therapeutic and teaching approach is centered on a shared decision-making model. The nature of this work is that success comes not from a technique, but from allowing that technique to be uniquely personal for each person to whom it is applied. It is through the relationship we build and the feedback we gain from following an exclusionary model of care that our work becomes personal. In each workshop, I tend to see participants moving rather quickly through each technique sequence, finishing up and waiting for what's next. But it is through time and patience that context is noted and established. As you begin incorporating the class concepts, keep this in mind: this work is less about the specifics of the technique we apply and more about how we modify it to address the specific needs of our patients.
Techniques drive the research. Empathy and listening define the therapeutic relationship.
Charles, C., Whelan, T., & Gafni, A. (1999). What do we mean by partnership in making decisions about treatment?. Bmj, 319(7212), 780-782.

02/18/2026

"Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging"
Conclusions and Relevance
In this population-based study, RC (rotator cuff) abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms. These findings suggest that RC abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain.

This cross-sectional study assesses the prevalence of shoulder rotator cuff abnormalities in a general Finnish population and whether diagnostic imaging should guide diagnosis or treatment of atraumatic shoulder pain.

01/07/2026

Health, medical, and fitness industries seem to have forgotten (or never learned) that exercise's effects on pain are nuanced and multidimensional, and extend far beyond "getting stronger. This paper is now a handout ready to share with patients. Pain (and other functional deficits) is complex and can never be reduced to a single cause or mechanism of change.
Powell, J., Wood, L., Cashin, A. G., & Lewis, J. S. (2025). It is not all about strength: rethinking mechanistic assumptions in exercise-based rehabilitation for musculoskeletal pain relief. British journal of sports medicine, bjsports-2025-110372. Advance online publication. https://doi.org/10.1136/bjsports-2025-110372

12/31/2025

This video was recorded on my recent teaching trip in Mumbai and Bengaluru, India, in November 2025. Demonstrations such as these are not intended to prove a therapeutic effect. However, they do show that when we perform manual therapy on the laryngeal region, there are direct effects on relevant internal structures. Modern mechanisms-of-action narratives for manual therapy have transcended the view that change occurs solely as a result of the clinician's expertise and have shifted the onus for change onto the patient. If manual therapy is combined with functional efforts on the patient's part, and the manual therapy input replicates or somehow connects with those issues, these modern perspectives on manual therapy impacts allow us to see how therapeutic benefits can result from such exposure.

From such demonstrations, I hope to foster curiosity among the professions. Might manual therapy have a role in the diagnosis of voice and swallowing-related disorders? https://youtu.be/n_Wbi1KD45g

For more information on this work, including in-person and online courses, please refer to https://www.waltfritz.com/

Here are a few sources of the updated mechanism of action for manual therapy:

1. Bialosky, J.E., Cleland, J.A., Mintken, P., et al. (2021) The healthcare buffet: preferences in the clinical decision-making process for patients with musculoskeletal pain. Journal of Manual & Manipulative Therapy.

2. Geri, T., Viceconti, A., Minacci, M., Testa, M., & Rossettini, G. (2019). Manual therapy: Exploiting the role of human touch. Musculoskeletal science & practice, 44, 102044.

3. Keter, D. L., Bialosky, J. E., Brochetti, K., Courtney, C. A., Funabashi, M., Karas, S., Learman, K., & Cook, C. E. (2025). The mechanisms of manual therapy: A living review of systematic, narrative, and scoping reviews. PloS one, 20(3), e0319586.

4. Kolb, W.H., Wallace McDevitt, A., Young, J. et al. (2020) The evolution of manual therapy education: what are we waiting for?, Journal of Manual & Manipulative Therapy, 28:1, 1-3.

5. Roy, N., Dietrich, M., Blomgren, M., Heller, A., Houtz, D. R., & Lee, J. (2019). Exploring the neural bases of primary muscle tension dysphonia: a case study using functional magnetic resonance imaging. Journal of Voice, 33(2), 183-194.

https://youtu.be/n_Wbi1KD45g

This video was recorded on my recent teaching trip in Mumbai and Bengaluru, India, in November 2025. Demonstrations such as these are not intended to prove a...