Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study

Prevalence of text neck syndrome, its impact on neck dysfunction, and its associated factors among medical students: A cross-sectional study

BACKGROUND

Students increasingly rely on digital devices, leading to text neck syndrome, a common overuse syndrome caused by repetitive forward neck flexion.

OBJECTIVE

This study aimed to determine the prevalence of text neck syndrome among medical students and the resulting neck dysfunction and to investigate the possible associated factors.

METHODS

This cross-sectional study used an online self-developed questionnaire among medical students. Students' characteristics and data about smartphone usage were evaluated for diagnosis. Individuals with at least 3 of the 6 text neck syndrome symptoms and a history of more than four hours a day spent on a smartphone were diagnosed with text neck syndrome. Neck dysfunction was measured using the neck disability index. Descriptive statistics and the chi-square test were used. P values < 0.05 were considered statistically significant.

RESULTS

The study found that 31.7% of students with text neck syndrome have mild neck disabilities, with a higher proportion of females (40%). The characteristics that have a significant relation to text neck syndrome include being female (p < 0.0001), overweight (p = 0.025), being right-handed (p = 0.001), using four digital devices or more (p = 0.002), having low levels of physical activity (P = 0.018), and spending more than three hours a day sitting down (P = 0.027).

CONCLUSION

More than a quarter of medical students had text neck syndrome, and most of them had a mild neck disability. Text Neck Syndrome was linked to an increased number of gadgets used, low exercise, and more time spent in a sitting position.

Gender differences in neck muscle activity during near-maximum forward head flexion while using smartphones with varied postures

Women frequently express heightened neck discomfort even though they exhibit smaller neck flexion (NF) during smartphone use. Differences in natural posture while using smartphones may result in varying muscle activation patterns between genders. However, no study focused on this issue. This study investigated the influence of gender on neck muscle activity and NF when using smartphones, ranging from slight (20°) to nearly maximal forward head flexion, across different postures. We analyzed smartphone usage patterns in 16 men and 16 women and examined these behaviors across different scenarios: standing, supported sitting, and unsupported sitting, at 20°, 30°, 40°, and the maximum head angles. During data collection, muscle activity was measured, expressed as a percentage of the maximum voluntary contraction (%MVC), in the cervical erector spinae (CES) and upper trapezius (UTZ), along with NF. Results show significant influences of gender, head angle, and posture on all measures, with notable interactions among these variables. Women displayed higher muscle activities in CES and UTZ, yet exhibited lesser NF, while using smartphones in both standing (12.3%MVC, 10.7% MVC, and 69.0°, respectively) and unsupported sitting (10.8%MVC, 12.3%MVC, and 71.8°, respectively) compared to men (standing: 9.5%MVC, 8.8%MVC, and 76.1°; unsupported sitting: 9.7%MVC, 10.8%MVC, and 76.1°). This study provides a potential rationale for gender-related disparities in injury outcomes, emphasizing that women experience higher neck and shoulder discomfort level, despite their smaller NF during smartphone use, as found in previous research. Additionally, the cervical flexion-relaxation phenomenon may occur when the head angle exceeded 40°. The near-maximum head angle during smartphone use might induce the cervical flexion-relaxation phenomenon, potentially aggravating neck issues. We recommend limiting smartphone usage postures that exceed the near-maximum head angle, as they are commonly adopted by individuals in the daily smartphone activities.

The effect of emotion regulation strategies on nomophobia in college students: The masking role of resilience

College students have a high prevalence of nomophobia. However, research on the effects of emotion regulation and resilience on nomophobia in China is lacking. This research investigated how cognitive reappraisal and expressive suppression strategies directly and indirectly affect nomophobia through resilience. Therefore, from March to May 2023, 756 university student volunteers (21.4 % men) were selected from a university in northeastern China for a questionnaire survey. Our findings suggest that college students' resilience has a masking effect on the relationship between cognitive reappraisal and nomophobia and can attenuate the negative effect of the frequency of using cognitive reappraisal strategies on nomophobia. The frequency of expressive suppression strategies directly and positively affected nomophobia. Early psychological interventions targeting resilience might be potentially effective in alleviating nomophobia among college students.

Text neck is not associated with neck and upper limb disability in young adults who use smartphones

PURPOSE

The objective of the present study was to correlate neck and upper-limb disabilities with neck flexion in university students who are smartphone users. While handling smartphones, a posture with sustained neck flexion known as "Text Neck" is usually adopted, and some authors related to musculoskeletal symptoms on the neck and the upper limb. However, recent studies state that such an association is questionable.

METHODS

This is an observational study when evaluating 192 university students through questionnaires such as the Neck Disability Index (NDI), Disabilities of Arm, Shoulder, and Hand (DASH), besides the maximal neck flexion, grip and lateral pinch strength of the participants.

RESULTS

The sociodemographic questionnaire demonstrated that most participants had used the device for 5 to 10 years, for five or more hours per day. The DASH questionnaire scores presented an average of 7.2 points, while the data regarding grip and lateral pinch strength showed averages of 29.5 kgf and 8.8 kgf, respectively. The NDI questionnaire scores presented an average of 10.5. The average range of motion of the maximum neck flexion was 27°.

CONCLUSION

There was no association between neck flexion with the DASH and NDI or the grip and lateral pinch strength after the correlation and binary logistic regression analyses. The results show that the scores of DASH, NDI, hand grip and lateral pinch strength, have no association with the maximum neck flexion.

Effect of Mobile Phone Use on Musculoskeletal Complaints: Insights From Nursing Students at Northern Border University, Arar, Saudi Arabia

Introduction Smartphones are widely utilized by individuals on a daily basis for a variety of activities, including communication, web browsing, and gaming. However, the excessive and prolonged use of these devices often leads to adverse effects on musculoskeletal health. This study aimed to assess the effect of mobile phone use on musculoskeletal complaints among nursing students at Northern Border University. Methods An analytical descriptive study was conducted using a convenience sample of 202 nursing students recruited via a Google survey questionnaire. The questionnaire comprised four sections concerning the students' demographics, smartphone data collection tools, the Smartphone Addiction Scale (SAS-SV), and the Nordic Musculoskeletal Questionnaire (NMQ). Results Among the study participants, 62.6% were females, with 52.4% spending more than 5 hours daily on media and technology usage, often extending into bedtime. In the last 12 months, neck pain was the most prevalent complaint, reported by 38.8% of the participants, followed by shoulder pain experienced by 20.3% of the sample. Notably, female students displayed a significantly higher incidence of musculoskeletal pain, with rates as high as 81.7% showing statistical significance (p<0.001). A significant association was also observed between mobile phone addiction and academic grade, as well as the time spent on media and technology usage daily (p<0.001). Conclusions There is a significant association between mobile phone use and discomfort in the musculoskeletal system, particularly in the neck region. Moreover, female students tend to experience more pronounced musculoskeletal discomfort compared to their male counterparts. The study also suggests that extended usage of mobile phones, especially at bedtime, increases the likelihood of experiencing musculoskeletal discomfort.

A comparison between the lecture and self-study methods on female students' awareness and attitudes about text neck syndrome

BACKGROUND

Text Neck Syndrome (TNS) is a common issue in the neck. The emergence of such issues makes it more pressing to offer ergonomic training to prevent their consequences. The present study aimed to compare training through the lecture and Self-Study methods awareness and attitudes about the TNS.

MATERIALS AND METHODS

The study was conducted on 94 female high-school students in 2021, and a quasi-experimental methodology was implemented. The participants were randomly divided into a lecture method and a self-study group. A researcher-made questionnaire was utilized for data collection to measure the participants' attitudes and awareness. The data were analyzed according to descriptive and inferential statistics.

RESULT

The findings showed that the mean post-test scores of the participants' awareness in the lecture method and self-study groups were 8.74 and 5.83, respectively, and a significant increase was observed in the post-test scores of the lecture method group. However, no significant difference was observed between the pre-test and post-test attitude scores of the two groups.

CONCLUSION

As training by the use of the lecture method in a webinar format has the characteristics of a traditional and online educational simultaneously, it offers an advantage that can be utilized in educational institutions as a complementary (or even an independent) method. Moreover, the experts in medical informational sciences need to accompany training groups as they are responsible to select and prepare credible content materials for audiences.

Self-Management Exercises Intervention on Text Neck Syndrome Among University Students Using Smartphones

BACKGROUND

The prevalence of neck pain due to the overuse of mobile phones has been reported among university students.

AIM

This study aims to investigate the impact of self-management corrective exercises on text neck syndrome among university students using smartphones.

METHODS

This experimental study was conducted on 60 students in the two experimental and control groups. Demographic information and the Neck Disability Index (NDI) questionnaires were used for data collection. The Severity of Neck Pain (SNP) was determined using the visual analog scale. The head and neck tilt angles, the gaze angle, and the amount of change in the forward head posture were determined using photogrammetry and Kinovea software. The experimental group performed corrective exercises 5 days a week for 8 weeks. The desired variables were re-determined in both groups after the intervention.

RESULTS

The SNP and NDI in the experimental group after the intervention decreased by 0.61-1.45, and 1.20-5.14, respectively. Significant differences between the measured variables before and after the intervention in the experimental group showed that the head tilt angle (7.17-22.30 degrees), gaze angle (3.21-23.5 degrees), and forward head posture (3.26-5.42 cm) were reduced, and the neck tilt angle (2.00-17.24 degrees) increased and improved after the intervention in various measurement positions.

CONCLUSIONS

After performing the corrective exercises, 36.6% of the SNP and 13.3% of the NDI were reduced in the experimental group. Head and neck angles during using smartphones in a sitting position on a chair without a backrest were the most awkward posture compared with other postures.

Defining text neck: a scoping review

BACKGROUND

Text neck is regarded as a global epidemic. Yet, there is a lack of consensus concerning the definitions of text neck which challenges researchers and clinicians alike.

PURPOSE

To investigate how text neck is defined in peer-reviewed articles.

METHODS

We conducted a scoping review to identify all articles using the terms "text neck" or "tech neck." Embase, Medline, CINAHL, PubMed and Web of Science were searched from inception to 30 April 2022. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. No limitation was applied for language or study design. Data extraction included study characteristics and the primary outcome relating to text neck definitions.

RESULTS

Forty-one articles were included. Text neck definitions varied across studies. The most frequent components of definitions were grouped into five basis for definition: Posture (n = 38; 92.7%), with qualifying adjectives meaning incorrect posture (n = 23; 56.1%) and posture without a qualifying adjective (n = 15; 36.6%); Overuse (n = 26; 63.4%); Mechanical stress or tensions (n = 17; 41.4%); Musculoskeletal symptoms (n = 15; 36.6%) and; Tissue damage (n = 7; 17.1%).

CONCLUSION

This study showed that posture is the defining characteristic of text neck in the academic literature. For research purposes, it seems that text neck is a habit of texting on the smartphone in a flexed neck position. Since there is no scientific evidence linking text neck with neck pain regardless of the definition used, adjectives like inappropriate or incorrect should be avoided when intended to qualify posture.

Pediatric Text Neck Syndrome

Text neck syndrome is a growing concern in the pediatric population due to the increased use of mobile devices and screens, potentially leading to long-lasting musculoskeletal issues. This case report presents a six-year-old boy with a one-month history of cephalgia and cervicalgia, who initially received insufficient care. After nine months of chiropractic intervention, the patient reported significant improvements in pain relief, neck mobility, and neurological symptoms, supported by radiographic findings. This report emphasizes the importance of early recognition and intervention in pediatric patients, as well as the role of ergonomics, exercise, and proper smartphone usage habits in preventing text neck and maintaining spinal health.

The Prevalence of Mild, Moderate, and Severe Nomophobia Symptoms: A Systematic Review, Meta-Analysis, and Meta-Regression

NOMOPHOBIA, or NO MObile PHone Phobia, refers to a psychological condition in which people fear being disconnected from their mobile phones. The purpose of this review was to establish the prevalence of nomophobia symptoms in youth and young adults according to severity, country, culture, population, measurement tool, and year of data collection. An electronic search of fourteen databases, two digital preservation services, and three content aggregator services was conducted from the inception of each database until 15 September 2021. A total of 52 studies involving 47,399 participants from 20 countries were included in the analyses. The prevalence of nomophobia was defined as the proportion of individuals scoring at or above established cut-offs on validated measures. Based on a random-effects meta-analysis, approximately 20% of individuals showed mild symptoms of nomophobia, 50% showed moderate symptoms, and 20% showed severe symptoms. Our results showed that university students from non-Western cultures are the most likely to suffer severe symptoms. In the year 2021, the prevalence rate of nomophobia increased. The instrument that was best able to detect nomophobia was the nomophobia questionnaire. Most individuals who own mobile phones experience mild or moderate symptoms of nomophobia. Severe symptoms deserve attention from clinicians and research scientists. A valid method of identifying individuals with a severe addiction to their mobile phones will help with timely and effective therapeutic management.

Comparing the effect of the posture of using smartphones on head and neck angles among college students

Smartphone users' posture can affect the musculoskeletal load of the user's neck. This study aims to compare the effect of the posture of using smartphones on head and neck angles among college students. The cross-sectional study was conducted among 80 college students. The Severity of Neck Pain (SNP) and the head and neck tilt angles, the gaze angle, and the amount of change in the forward head posture were determined. The angles were measured in three postures including standing, sitting on a chair with and without a backrest. Most of the participants (51.3%) reported moderate and severe neck pain. The angles during using smartphone had a significant difference in different positions, so that the best head (100.6 ± 11.3°) and neck (32.5 ± 11.2°) tilt angles and gaze angle (58.2 ± 13.7°) were in sitting position with leaning on a backrest of the chair. Head (109.6 ± 14.4°) and neck (22.0 ± 12.6°) tilt angles, and the forward head posture (15.9 ± 4.9 cm) have the worst posture in sitting position on a chair without a backrest while gaze angle (67.1 ± 12.0°) has the most awkward posture in standing. Practitioner summary: The posture of using a smartphone affects the amount of pressure on the neck. This study aims to investigate the effect of different positions of using smartphone on head and neck angles among Iranian university students. The angles during using smartphone had a significant difference in different positions.

Employment-related musculoskeletal complications experienced by the physical therapists in Bangladesh: a comprehensive cross-sectional case study

Background

Dentists, nurses, and physical therapists have all been associated with an increased risk of work-related diseases. The findings of studies in these different occupations might aid in the development of preventative measures. In Bangladesh, however, no comparable evidence has been recorded among physical therapists. The study’s goal was to find out the prevalence of work-related physical problems at different anatomical locations, as well as the link between these disorders and treatment strategies across Bangladeshi physical therapists.

Methods

A physical and online survey of Bangladeshi physical therapists was done. A total of 300 questionnaires were given out, with work-related discomfort or pain detected in nine locations of the body: (1) neck, (2) shoulder, (3) elbow, (4) wrists, (5) upper back, (6) lumbar, (7) thighs, (8) knee, and (9) ankle.

Results

85.5% of Bangladeshi physical therapists suffer musculoskeletal problems, according to the results of this research. The neck (25.7%), lower back (15.2%), elbow (12.3%), ankle (8.6%), and shoulder (8.6%) were the most often affected locations (7.1%). Upper back (3.0%) and hips (2.2%) ailments had the lowest prevalence.

Conclusion

Work-related musculoskeletal illnesses were common among the Bangladeshi physical therapists, especially in their neck, lower back, elbow, and ankle regions.

The Relationship between Cellphone Usage on the Physical and Mental Wellbeing of University Students: A Cross-Sectional Study

(1) Background: The study aims to examine the use of cell phones on physical and mental health status and their impact on personality among university students. (2) Methods: A cross-sectional study was conducted using a semi-structured questionnaire. The association of physical and mental health variables with the demographic variables was examined using Pearson’s correlation and χ2-test. The binary logistic regression model was further used to predict the probabilities of negative impact on personality due to excessive use of cell phones. (3) Results: A total of 400 participants participated with a mean age of 24.45 ± 3.45 years. The average eye strain was more in High cell phone users HCPU than in LCPU and that difference was significant p = 0.000. The average neck pain was more in (HCPU) than Low cell phone users (LCPU) and there was a significant difference between the two groups with p = 0.006. The average weight gain was more in HCPU than LCPU and that difference was significant p = 0.000. Considering back pain, back pain was found more in HCPU as compared to LCPU with a statistical difference at p = 0.027. Cell phone usage significantly correlated with eye strain (r = 0.577, p = 0.000), neck pain (r = 0.543, p = 0.000), back pain (r = 0.611, p = 0.000), weight gain (r = 0.423, p = 0.000), depression (r = 0.430, p = 0.000), loneliness (r = −0.276, p = 0.002), and mood disorder (r = 0.608, p = 0.000). Eye strain, neck pain, and back pain was observed more in HCPU than in LCPU. HCPU felt they gained more weight when compared to the respondents in the LCPU group. HCPU felt more changes in mood and feeling low when compared to the LCPU, while LCPU group felt more lonelier when compared to the HCPU group. (4) Conclusions: The study highlights a significant association between excess use of cell phones and negative effects on physical and mental health wellbeing. Based on the results, it is recommended that more physical activities and alternative to minimize cell phone usage should be planned for the students. Public health policy makers and stakeholder need to address the ill effects of excessive use of cell phones through novel policies., especially young students, and alternatives to reduce their cell phone activities.

Preventing the progression of text neck in a young man: A case report

Text neck describes an overuse injury of the cervical spine resulting from the repetitive stress of prolonged forward head flexion while looking down on a mobile screen. This case report describes a 24-year-old young man who presented with a 12-month history of head and neck pain and paresthesia of the right upper limb. The patient worked as a YouTuber and has been editing and posting videos on the website for three years. One year prior to referral for chiropractic assessment, the patient first visited his family physician for similar complaints. Based on cervical radiographs, the diagnosis of cervical spondylosis was given. Previous management included pain medication and muscle relaxants. Interventions included repeated physical therapy, cervical traction, and acupuncture, with some temporary relief during the subsequent year. However, severe flare-up of the symptoms occurred, which was brought about by working for extended periods on his smartphone, for which the patient sought chiropractic attention. X-ray imaging showed cervical kyphosis with C5 vertebral rotation, hypertonicity of the paraspinal muscles, and paresthesia in the right C6 dermatome distribution, which were consistent with text neck syndrome associated with cervical spondylosis and right C6 radiculopathy. The intervention consisted of improving posture while texting, cervical manipulation, and extension traction therapy. After 9 months of treatment sessions, the symptomatic and functional improvement was reflected by the radiographic changes in the cervical curve correction and the normalized paraspinal muscle tension on surface electromyology. Frequent breaks along with correct posture while using smartphones will be the key entities to prevent the occurrence of text neck syndrome.

Smartphone addiction and its impact on musculoskeletal pain in neck, shoulder, elbow, and hand among college going students: a cross-sectional study

Introduction

Prolonged physical exposure during smartphone usage results in poor posture causing pain in neck, shoulder, elbow, and hands. So, our aim was to investigate the effect of smartphone addiction on musculoskeletal pain.

Methods

This cross-sectional study was carried out by a random sampling method from recognized institute in Bangladesh and India. Three hundred twenty-six participants, including male and female, aged between 18 and 30 years participated in this study. Candidates were requested to fill-up a performa containing demographics, Smartphone addiction scale-short form (SAS-SF), Shoulder pain and disability index (SPADI), Neck disability index (NDI), Oxford elbow score (OEC), and Cornell Hand Discomfort Questionnaire (CHDQ).

Results

The mean age were 22.58 ± 3.19 years, weight 60 ± 11.30 kg, height 162.83 ± 9.74 cm, and body mass index (BMI) of the participants were 22.69 ± 4.36 kg/m2. 43.3% participants reported neck pain, 42.9% shoulder pain, and 27.9% reported pain on their elbow while prolonged smartphone use. There was major difference in NDI (p = 0.047), SPDI (p = 0.005), OES (p = 0.002), and CHDQ (p = < 0.001) among Bangladeshi and Indian population. The SAS has a significant association with NDI; p < 0.001, SPDI; p < 0.001, OES; p < 0.001, and CHDQ; p < 0.001.

Conclusion

Smartphone addiction negatively impacted and positively related with the musculoskeletal pain in neck, shoulder, elbow, and hand. Care should be given towards the proper use of smartphone and increase public awareness regarding the negative consequences of this serious issue.