An analysis of the activity and muscle fatigue of the muscles around the neck under the three most frequent postures while using a smartphone

Association between smartphone addiction and myofascial trigger points

BACKGROUND

The purpose of this study was to clarify the relationship between smartphone addiction and miyafascial trigger points in university students.

METHODS

A cross-sectional study of university students was conducted for the purpose of this study. The participants were assessed based on age, gender, dominant side, the amount of time they spent on their smartphones, the purpose of their use, and their posture. The Smartphone Addiction Scale Short Form (SAS-SF) was used to determine addictes and non-addicts. The cut-off value of SAS-SF is 31 and above for male and 33 and above for female.

RESULTS

There were 136 participants in the study. The posture score for addicts and non-addicts ones was not significantly different (p > 0,05), but the number of trigger points, maximal bending posture and trigger points in the right levator scapula and right cervical erector muscles were significantly higher in the smartphone addict participants (p < 0,05).

CONCLUSIONS

Smartphone addiction in university students is associated with postural changes and trigger points in the bilateral levator scapula and right cervical erector muscles. Public health programs should be developed to raise awareness about smartphone addiction, encourage screen breaks, and emphasize physical activity and exercise regularly.

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.

Perceived Discomfort, Neck Kinematics, and Muscular Activity During Smartphone Usage: A Comparative Study

OBJECTIVE

The present study aims to evaluate the effects of posture, task, and handgrip style on discomfort, neck kinematics, and concomitant muscular activity when using a smartphone (SP).

BACKGROUND

Along with the popularity of smartphones, musculoskeletal disorders have become prevalent among smartphone users. However, comprehensive aspects of discomfort, kinematics, and electromyographic responses across various conditions remain to be investigated.

METHOD

Twenty-four young smartphone users performed typing, video watching, and reading tasks while holding the smartphone both with one hand and with two hands while either sitting or standing. Neck kinematics and muscular activities were simultaneously recorded.

RESULTS

Working with SPs led to higher discomfort in the neck (p = 0.01), lower back (p = 0.01), and shoulder (p = 0.04) while sitting as compared to standing. Sitting was associated with greater neck flexion and more minor lateral bending for all tasks and grip styles (p < 0.05). Electromyographic analysis indicated significant differences between sitting and standing, with alterations being dependent on the test condition. Moreover, neck kinematics and muscular activities significantly differed based on the task nature, handgrip, and interactions.

CONCLUSION

This study highlights the risk of using smartphones in increased neck angle flexion and muscular activities fatigue. Thus, posture and handgrip should be considered while using SPs. As each test condition affects a specific dependent variable, a holistic approach is required to evaluate the responses of SP users' musculoskeletal systems.

APPLICATION

Results can be applied to develop guidelines for musculoskeletal disorders/discomfort prevention among SP users, especially with the rise of smartphone use during the COVID-19 pandemic.

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.

Effects of Using a Shoulder/Scapular Brace on the Posture and Muscle Activity of Healthy University Students during Prolonged Typing-A Randomized Controlled Cross-Over Trial

Laptop use appears to contribute to poor working postures and neck pain among university students. Postural braces have the potential to improve upper back/neck posture and therefore might have a role as an ergonomic aid for this population. Therefore, the purpose of this study was to assess the short-term effects of scapular bracing on pain, fatigue, cervicothoracic posture, and the activity of the neck and upper-back muscles in healthy college students. A randomized controlled crossover trial was conducted to evaluate the self-reported pain and fatigue, the amplitude and median frequency of surface electromyography in neck extensors, upper trapezius, and lower trapezius, as well as the neck and shoulder sagittal alignment (measured by inertial sensors and digital photographs) during a 30-min typing task in a sample of young, healthy university students with or without a scapular brace. The brace condition resulted in significantly smaller levels of bilateral trapezius muscle activity (p < 0.01). Rounded shoulder posture was slightly better in the brace condition, but these differences were not significant (p > 0.05). There were no significant immediate differences in pain or fatigue scores, neck alignment, or the electromyographic activity of the other muscles tested between brace and non-brace conditions (all p > 0.05). However, bracing appears to immediately reduce the electromyographic activity of the lower trapezius muscles (p < 0.05). These findings shed some light on the possible advantages of scapular bracing for enhancing laptop ergonomics in this group of individuals. Future studies are warranted to evaluate the effects of different types of braces, the importance of matching the brace to the user, and the short- and long-term effects of brace use on computer posture and muscle activity.

Examination of muscular pain when using an innovative smartphone app for adults

BACKGROUND: Smartphones are very convenient and accessible communication devices. Smartphone usage over long durations with poor posture can lead to musculoskeletal pain in adult users. OBJECTIVE: To compare pain in the neck, shoulder, upper back, lower back, arm, hand, and eye regions. METHODS: Thirty-five asymptomatic adults aged 18-25 years were divided into two groups: 1. use of an innovative smartphone app for the promotion of ergonomic behaviour (app use) and 2. no use of the innovative smartphone app (no app use). Participants sat upright, holding a smartphone with two hands, eyes 30-40 cm away from the screen, with frequent breaks consisting of stretching the neck and hand muscles while resting the eyes. The task involved taking part in online social networking for a duration of 45 minutes. A body pain chart and the visual analog scale (VAS) were used to evaluate the location and severity of pain. RESULTS: Pain in the neck, shoulder, upper back, arm, and hand regions in the “app use” condition were significantly lower than in the “no app use” condition at 15, 30, and 45 min (p-value<0.05). However, there were negligible differences between the two groups for eye pain, and lower back pain. CONCLUSION: Pain in the neck, shoulder, upper back, and arm regions in adult users in the “app use” condition was less than in the “no app use” condition. We would recommend that adults use the innovative smartphone app to prevent the risk of musculoskeletal pain potentially caused by smartphone usage.

Health in the palm of your hand-part 2: design and application of an educational module for young people on the risks from smartphone abuse and the opportunities of telemedicine and e-Health

BACKGROUND

The evolution of mHealth is strictly related to the evolution of the mobile-technology and in particular of the smartphone. However, it is increasingly becoming clear that excessive use of the smartphone has implications for health in terms of emerging risks and in particular (I) the text neck, (II) the addiction, (III) the use of deceptive Apps in mHealth and today telemedicine and e-Health solutions to face this are strongly needed. What young people need is a package of solutions that allow them to tackle all three of these problems at the same time through dedicated tools and specific material on these topics. However up to now this is lacking. The purpose of the study was the design and application of a teaching package focused in this field and specific for young people, the target population for the emerging risks.

METHODS

A teaching package was developed in a school-work alternation program for the secondary schools at the Italian National Institute of Health, according the Italian Law. It was available on the basis of proposals offered publically. It provided a two weeks stage on the topics: the risks from smartphone abuse and Telemedicine and e-Health solutions.

RESULTS

A specific electronic survey in this field was available at the end of the stage. The survey was submitted to 500 young subjects (50% male; 50% females; mean age 15.9 y; std-dev 1.2 y) at school and/or in meeting initiatives. The outcome demonstrated: (I) that the knowledge on the postural risk (text neck) was very poor, while the desiderata of Apps for correcting the posture was very high; (II) the feasibility to obtain feedback on the risk of addiction through a cyber-psychology approach; (III) a worrying position in relation to non-medical Apps confused with the medical ones.

CONCLUSIONS

The study demonstrated how the young people mBorn can familiarize with some aspects of telemedicine and e-Health and be at the same time a kind of spreader of a correct vision of the ratio between user and smartphone and the knowledge on both the mTech and the related problems.

Health in the palm of your hand-part 1: the risks from smartphone abuse and the role of telemedicine and e-Health

BACKGROUND

The evolution of the Telemedicine and e-Health is strictly related to the evolution of the mobile-technology. If today it is possible to successfully use a wide range of mHealth applications, playing an important role in Telemedicine and e-Health, health care has surely a gratitude debt with the smartphone. However, it is increasingly becoming clear that excessive use of the smartphone has implications for health in terms of risks and it is therefore necessary to tackle the various gaps and/or the role that Telemedicine and e-Health itself has in this field.

METHODS

Through an overview to literature, Web and App stores the study faced the implications for health from the excessive use of the smartphone and therefore the various gaps and/or the role that Telemedicine and e-Health itself has in this area both in the prevention and in the monitoring with particular regard to the three components: eHealth, mHealth and eLearning.

RESULTS

The study found (I) as emerging risks: the text neck, the risk of addiction and the risk in the use of deceptive Apps in mHealth; (II) as Telemedicine and e-Health useful approach: the design of Apps for the text neck prevention and the relevant acceptance and effectiveness assessment; the design and application of electronic surveys for tele-assessment of the addiction risk; the design and application of information and training path on the deceptive Apps in mHealth.

CONCLUSIONS

The key role of Telemedicine and e-Health in the prevention and monitoring of the risks from smartphone abuse has been clearly identified and the young people has been identified as target population and the relevant need to design specific teaching packages in this field focused on them.

Correlation between craniovertebral angle in the sagittal plane and angles and indices measured in the frontal plane at the moment of inducing forward head posture

BACKGROUND

Forward head posture (FHP) is the most common malposition in the head and neck area. With the growing use of digital devices, the prevalence of FHP may be expected to increase dramatically. Thus far, FHP has been evaluated only in the sagittal plane.

OBJECTIVE

The objective of this study was to measure angles and indices from anatomical landmarks in the frontal plane and determine the possible correlations between these variables and craniovertebral angle (CVA) as an index of FHP in the sagittal plane.

METHODS

Fifty eight healthy individuals (29 men, 29 women) between 18 and 40 years old participated in this cross-sectional study. Participants were evaluated with an 8-camera motion analysis system. After markers were placed on predetermined landmarks, the participants were asked to maintain their head and neck in the neutral position for 5 seconds. Then participants induced FHP by flexing and lowering their head. The correlation between CVA and a set of angles and indices was calculated at the moment of FHP induction.

RESULTS

A moderate correlation was observed between 3-D CVA and the angle formed between the sternum and both tragi for the whole sample and separately in both sexes. A moderate negative correlation was observed between 3-D CVA and height, weight, and BMI in women. A moderate negative correlation was observed between 3-D CVA and height, weight, BMI, and hours on digital devices in men.

CONCLUSIONS

Changes in CVA in the sagittal plane can be predicted from changes in the angle formed between the midpoint of the sternum and the left and right tragi in the frontal plane.

Influence of smartphone use on the median frequency of mastigatory and trapezius muscles in women - a Pilot study

INTRODUCTION

The use of smartphones is growing every year, and their excessive use can cause adverse physical and mental effects.

AIM

This study aimed to evaluate the influence of smartphone use on the median frequency of the masticatory muscles and upper trapezius muscles in healthy women.

METHOD

Six healthy young women were evaluated. All the volunteers underwent a submaximal bite test to evaluate their masticatory muscles. In addition, the volunteers underwent a test for bilateral shoulder elevation to a submaximal load to evaluate their upper trapezius muscles. Both protocols were performed before and after a task using the smartphone for 30 min. Median frequency (MF) values were collected during the submaximal bite and submaximal shoulder elevation tests.

RESULTS

Data were analyzed using specific statistical tests. A statistically significant reduction in the MF for all the masticatory muscles was observed in the bilateral bite task when comparing pre and post smartphone use (p < 0.005). A significant reduction in the MF was also found for the right upper trapezius when comparing pre and post smartphone use in the shoulder elevation task (p = 0.001).

CONCLUSION

It appears that prolonged smartphone use may contribute to fatigue in the masticatory and upper trapezius muscles. Therefore, guidelines for smartphone users should include advice on the moderate use of this device.

Electromyographic analysis of upper trapezius, abductor pollicis longus and abductor pollicis brevis during smartphone use in different positions among young male and female subjects

BACKGROUND

Smartphone use has increased tremendously in recent times and there are various adverse musculoskeletal consequences associated with its use. Alteration in the activation patterns of muscles in certain positions may be the reason behind the development of musculoskeletal disorders in smartphone users; however, it has not been thoroughly investigated by the existing literature.

OBJECTIVES

To investigate the electromyographic (EMG) activity of upper trapezius (UT), abductor pollicis brevis (APB) and abductor pollicis longus (APL) during smartphone use in three different positions (standing, sitting on the chair and sitting cross legged on the floor) in young male versus female subjects.

METHODS

Twenty-six young male (age: 23.77 ± 2.47 years) and 26 young female (age: 22.45 ± 2.32 years) smartphone users were recruited from Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, New Delhi, India. EMG activity of UT, APB and APL muscles was examined using surface electrodes during a smartphone task in three different positions, i.e. standing, sitting on a chair, sitting cross-legged on the floor. The smartphone task consisted of typing English quotations for 20 s 3 times with a rest period of 10 s between each quotation and a 5-min interval between each position, respectively.

RESULTS

EMG activity of the UT muscle was found to be significantly reduced when sitting on a chair as compared to standing (p < 0.001) and sitting cross-legged (p = 0.008) during smartphone use. APB and APL muscle activity were not significantly different between the three positions (p > 0.05). Moreover, the activation patterns of these muscles did not differ in male and female subjects (p > 0.05).

CONCLUSION

The present study demonstrates that the UT muscle is least activated when sitting on chair as compared to standing and sitting cross-legged during smartphone use. Moreover, the activity of neck and thumb muscles does not vary significantly between male and female subjects during smartphone use in different positions. As UT muscle activation significantly varies with the position of smartphone use, thus, the position adopted during smartphone use should be taken into consideration and the position which causes least strain on muscles, i.e. sitting on the chair should be adopted.

The associations of mobile touch screen device use with musculoskeletal symptoms and exposures: A systematic review

BACKGROUND

The use of mobile touch screen devices (MTSDs) has increased rapidly over the last decade, and there are concerns that their use may have negative musculoskeletal consequences; yet evidence on the association of MTSD use with musculoskeletal symptoms and exposures is currently dispersed. The aim of this study was to systematically review available literature on musculoskeletal symptoms and exposures associated with MTSD use. The synthesised information may facilitate wise use of MTSDs and may identify areas in need of further research.

METHODS

EMBASE, Medline, Scopus, PsycINFO and Proquest electronic databases were searched for articles published up to June 2016, using keywords describing MTSD, musculoskeletal symptoms (e.g. pain, discomfort) and musculoskeletal exposures (e.g. posture, muscle activity). Two reviewers independently screened the articles, extracted relevant data and assessed methodological quality of included studies. Due to heterogeneity in the studies, a meta-analysis was not possible and a structured narrative synthesis of the findings was undertaken.

RESULTS

A total of 9,908 articles were screened for eligibility with 45 articles finally included for review. Included articles were of cross-sectional, case-control or experimental laboratory study designs. No longitudinal studies were identified. Findings were presented and discussed in terms of the amount, features, tasks and positions of MTSD use and its association with musculoskeletal symptoms and musculoskeletal exposures.

CONCLUSIONS

There is limited evidence that MTSD use, and various aspects of its use (i.e. amount of usage, features, tasks and positions) are associated with musculoskeletal symptoms and exposures. This is due to mainly low quality experimental and case-control laboratory studies, with few cross-sectional and no longitudinal studies. Further research is warranted in order to develop guidelines for wise use of MTSDs.