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Smartphone use addiction can cause neck disability

  • PhysioTrio Clinic


The present study demonstrated that addiction to smartphone use is associated with neck problems and disability among healthy young adult subjects. This finding supports earlier work showing a high level of computer use‐related musculoskeletal symptoms around the neck among young college students (Jenkins et al., 2007), and that smartphone addiction caused physical health‐related problems (Kwon et al., 2013). The neck disability among smartphone users might be related to frequent neck flexion posture (Bababekova, Rosenfield, Hue & Huang, 2011; Janwantanakul, Sitthipornvorakul & Paksaichol, 2012), which changes the natural curve of the cervical spine and increases the amount of stress on the cervical spine (Hansraj, 2014), leading to irritation and spasm in the surrounding skeletal structures and ligaments (Fredriksson et al., 2002), and proprioception deficits in the cervical vertebra (Kim, Kang, Kim, Jang & Oh, 2013). Excessive use of smartphones can lead to habitual repetitive and continuous movements of the head and neck toward the screen throughout the day. Such movements are associated with a high risk of chronic neck pain (Veiersted & Westgaard, 1993) and may explain the strong association between SAS and NDI scores in the present study.
Smartphone use addiction can cause neck disability
Sami S. AlAbdulwahab PT PhD |Shaji John Kachanathu PT PhD |
Mohammed Saleh AlMotairi PT
Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Kingdom of Saudi Arabia
Dr Shaji John Kachanathu, P.O Box 10219, Building #: 24, Department of Rehabilitation Health Sciences, College of Applied Medical Sciences, King Saud University,
Riyadh, 11433, Kingdom of Saudi Arabia.
A smartphone is one of the most popular devices among adolescents.
Advancement in smartphone models, including portable media players,
compact digital cameras, access to emails, GPS navigation units and
highresolution touch screens, contribute to the frequent use and
addiction to smartphones (Kwon et al., 2013). Along with the rise in
smartphone use, potential risks for musculoskeletal problems have
been reported (Kang et al., 2012; Kwon et al., 2013).
Most smartphone tasks require users to stare sharply downwards or
to hold their arms out in front of them to read the screen, which makes
the head move forward and causes an excessive anterior curve in the
lower cervical vertebrae and an excessive posterior curve in the upper
thoracic vertebrae to maintain balance, placing stresses on the cervical
spine and neck muscles (Berolo, Wells & Amick, 2011; Kang et al., 2012).
Forward head posture is one of the commonly recognized poor
postures in the sagittal plane. It has been indicated that this posture
might contribute to the onset and perpetuation of neck and back
pain syndromes, with further loss of cervical spine extension
(BurgessLimerick, Plooy & Ankrum, 1998; McEvoy & Grimmer,
2005). Forward head posture is determined by a dynamic combina-
tion of daily life factors, such as computer use (Brink, Louw, Grimmer
& Jordaan, 2014). Incorrect posture of the head and neck has been
correlated with chronic musculoskeletal pain (Lau, Cheung, Chan, Lo
& Chiu, 2010; Szeto, Straker & Raine, 2002).
The aim of the present study was to determine the level of
smartphone addiction and its relationship with neck function in healthy
young adult subjects.
A convenience sample of 78 healthy (based on university hospital
general practitioners screening) student subjects (39 females and 39
males) from King Saud University were recruited for the study via an
advertising poster. The sampling size was calculated with a confidence
level of 95% and ±0.5 error. Their mean age was 21.3 ± 1.7 years, mean
weight was 63.4 ± 15.9 kg and mean height was 1.66 ± 8.6 m. They
reported no history of any physical or mental diseases. They all used a
smartphone for several hours per day. The study was approved by the
Ethical Review Board of the Faculty of Applied Medical Sciences at
King Saud University (CAMS14236/37) and written informed consent
was obtained from each participant prior to their participation.
The study had a crosssectional design, to measure selfreported
addiction to smartphone use and any abnormal symptoms of neck
function using the Smartphone Addiction Scale (SAS) and Neck
Disability Index (NDI), respectively. The SAS and NDI questionnaires
were distributed electronically through emails, with detailed clarifica-
tion and explanation of the study's purpose and procedures.
2.1 |SAS
The SAS is a selfreporting scale to assess smartphone addiction (Kwon
et al., 2013). It consists of six factors and 33 items, with a sixpoint Likert
scale (1: strongly disagreeto 6: strongly agree). The six factors were
dailylife disturbance, positive anticipation, withdrawal, cyberspaceori-
entated relationship, overuse and tolerance. The respondent circles the
statement which most closely describes their smartphone use charac-
teristics. Scores range from 33 to 198. The higher the score, the greater
the degree of pathological use of the smartphone (Ching et al., 2015).
The SAS is a reliable and valid measurement tool for the evaluation
of smartphone addiction (Kwon et al., 2013).
2.2 |NDI
The NDI assessment involves a 10item, 50point index questionnaire
that assesses the effects of neck pain and symptoms during a range
of functional activities (Vernon & Mior 1991). Of the 10 items, four
relate to subjective symptoms (pain intensity, headache, concentration,
sleeping), four to activities of daily living (lifting, work, driving, recrea-
tion) and two to discretionary activities of daily living (personal care,
DOI 10.1002/msc.1170
Musculoskeletal Care 2017; 13 Copyright © 2017 John Wiley & Sons, 1
reading) (Stratford et al., 1999; Westaway, Stratford & Binkley, 1998).
Each item is scored on a 0 to 5 rating scale, in which zero means No
painand 5 means Worst imaginable pain. The test was interpretated
as a raw score, with a maximum score of 50. A higher NDI score indi-
cates greater neck disability. This index is the most widely used and
most strongly validated instrument for assessing selfrated disability
in patients with neck pain (Vernon, 2008).
2.3 |Data analysis
Data analyses were performed using SPSS 16.0 software for Windows
(SPSS, Chicago, IL, USA). The numerical scores of SAS and NDI were
presented as mean ± standard deviation. The Spearman correlation
coefficient was used to assess the relationship between SAS and NDI
scores. The significance level was set at p0.05.
The result of the study showed a clear association between addiction
to smartphone use and various degrees of neck problems among the
participants. The mean SAS and NDI scores were 119.4 ± 20.7 and
20.98 ± 5.1, respectively. The Spearman correlation coefficient
showed a significant correlation (p< 0.05) between SAS and NDI
scores (Table 1).
The present study demonstrated that addiction to smartphone use is
associated with neck problems and disability among healthy young adult
subjects. This finding supports earlier work showing a high level of com-
puter userelated musculoskeletal symptoms around the neck among
young college students (Jenkins et al., 2007), and that smartphone
addiction caused physical healthrelated problems (Kwon et al., 2013).
The neck disability among smartphone users might be related to
frequent neck flexion posture (Bababekova, Rosenfield, Hue & Huang,
2011; Janwantanakul, Sitthipornvorakul & Paksaichol, 2012), which
changes the natural curve of the cervical spine and increases the
amount of stress on the cervical spine (Hansraj, 2014), leading to irrita-
tion and spasm in the surrounding skeletal structures and ligaments
(Fredriksson et al., 2002), and proprioception deficits in the cervical
vertebra (Kim, Kang, Kim, Jang & Oh, 2013).
Excessive use of smartphones can lead to habitual repetitive and
continuous movements of the head and neck toward the screen
throughout the day. Such movements are associated with a high risk of
chronic neck pain (Veiersted & Westgaard, 1993) and may explain the
strong association between SAS and NDI scores in the present study.
The present study supports the need for public health educational
programmes to inform people of the physical risks associated with
excessive use of smartphones. In conclusion, smartphone addiction
could cause significant neck disability because of the bad posture asso-
ciated with their use. Bad posture associated with the use of
smartphones may be the reason for neck function impairment. Individ-
uals should make an effort to reduce the amount of time spent using a
smartphone, and try to maintain an appropriate posture during its use.
The authors would like to extend their appreciation to the Deanship of
Research, Research Center, College of Applied Medical Sciences at
King Saud University for constructive scientific support during this
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TABLE 1 Mean, standard deviation and correlation of Smartphone
Addiction Scale (SAS) and Neck Disability Index (NDI)
Variable (n= 78) Mean ± standard deviation
SAS 119.4 ± 20.7
NDI 20.98 ± 5.1
Correlation coefficient p< 0.018
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How to cite this article: AlAbdulwahab, S. S., Kachanathu, S.
J., and AlMotairi, M. S. (2017), Smartphone use addiction can
cause neck disability, Musculoskeletal Care, doi: 10.1002/
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... To spend time on the internet for many reasons such as texting, playing games, watching videos, or social media, students use mobile phones, computers, or laptops for a long time and in a fixed posture (37). Nowadays, university students prefer mobile phones to computers due to the rapid development of mobile phones, their widespread use, availability, and popularity among university students (37). Most studies assert that prolonged stay in a fixed posture with increased neck flexion to see the screen of a smartphone cause cervical and spinal problems (38,39). ...
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... So the study proved the addiction of smartphone can be a major cause of neck disability. 16 The outcomes are in accordance with an investigation of Finnish young people which demonstrates that PC use and staring at the TV were related with neck and shoulder torment. It explicitly highlighted time spent on screen based exercises as a particular danger factor and a frail affiliation recommends that the screen based exercises are supporters of actual grievances. ...
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Teknolojik gelişmeler son yıllarda oldukça hızlı bir gelişim göstermektedir. Bu alanda en dikkat çekici gelişmeler de cep telefonlarında gerçekleşmiştir. Özellikle genç nesillerde kullanımı oldukça yaygın olmakla birlikte her yaştan kesimin kullandığı akıllı telefonlar yaşamın ayrılmaz bir parçası haline gelmiştir. Bireylerin yaşamlarında sağladığı yararlar ve kolaylıklar elbette göz ardı edilemez, ancak bilinçli kullanım sağlanmadığında bağımlılık gibi bir tehlikeye de zemin hazırlamaktadır. Aşırı kullanım alışkanlıkları nedeniyle kullanım sırasında edinilen postürün bireylerde oluşturacağı fiziksel problemler ile bağımlılık nedeniyle uyku kalitesinde bozulmalar meydana gelmekte, bireylerin yaşamları olumsuz etkilenmektedir. Aşırı akıllı telefon kullanımının neden olduğu düşünülen sosyal kaygı, anksiyete, depresyon, güvensizlik, telefonundan ayrılamama, yalnızlık ve izolasyon, nomofobi gibi psikolojik ve davranışsal sorunların yanı sıra yoğun akıllı telefon kullanımının öğrenme güçlüğü, bellek performansını ve karar verme becerisini olumsuz etkilemesi nedeniyle bireylerin hem iş hem de akademik performanslarında düşüş gözlemlenmektedir. Günümüzde akıllı telefon kullanımının çok küçük yaşlara kadar gerilediği düşünüldüğünde bireylerde akıllı telefon bağımlılığına karşı duyarlılık oluşturulması, bilinçli akıllı telefon kullanım tekniklerinin öğretilmesi ve bu bağlamda sağlık otoritelerinin, eğitim kurumlarının ve ebeveynlerin de bağımlılıkla mücadelede bir araya gelerek kapsamlı bir çalışma yapması önem arz etmektedir. Kullanıcılardaki bu bağımlılık riskinin ortadan kaldırılması ile akıllı telefon kullanımının neden olacağı fiziksel ve psikolojik problemlerde azalma, akademik performansta artış olacağı kanısındayız.
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This study investigates the impact of future technology products, as one of the parts of popular culture, on society in the science fiction novel Ready Player One by Ernest Cline (2011) and on our current society. The primary data of this study were taken from the novel. The results reveal that the effects of popular culture, specifically the products of technology, on modern society are enormous compared to the society in the novel. The similarities and differences between the technological aspects portrayed in the story compared to the current modern world are revealed to know what really happens and going to happen in the future.
Objectives The aim of this study was to examine the effects of problematic smartphone use on physical activity level and musculoskeletal pain. Methods Two hundred eighty university students (185 female; 95 male; mean age: 20.84±2.37 years) were included in the study. The International Physical Activity Questionnaire was used to determine the level of physical activity. Problematic smartphone use was determined using the Smartphone Addiction Scale-Short Form (SAS-SF) and musculoskeletal pain using the Nordic Musculoskeletal System Questionnaire. Results When SAS-SF scores were examined, it was seen that 31.8% (89 people) of the participants had problematic smartphone use. A moderate negative correlation was found between problematic smartphone use and physical activity level (p=0.0001; r=−0.419). Neck (p=0.017) and back pain (p=0.040) severity was higher in people with problematic smartphone use. Conclusions The findings show that problematic smartphone use has negative effects on both physical activity level and pain severity. For this reason, problematic smartphone use should be questioned in university students with neck and back pain.
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Introduction This study was initiated to determine the psychometric properties of the Smart Phone Addiction Scale (SAS) by translating and validating this scale into the Malay language (SAS-M), which is the main language spoken in Malaysia. This study can distinguish smart phone and internet addiction among multi-ethnic Malaysian medical students. In addition, the reliability and validity of the SAS was also demonstrated. Materials and Methods A total of 228 participants were selected between August 2014 and September 2014 to complete a set of questionnaires, including the SAS and the modified Kimberly Young Internet addiction test (IAT) in the Malay language. Results There were 99 males and 129 females with ages ranging from 19 to 22 years old (21.7±1.1) included in this study. Descriptive and factor analyses, intra-class coefficients, t-tests and correlation analyses were conducted to verify the reliability and validity of the SAS. Bartlett’s test of sphericity was significant (p <0.01), and the Kaiser-Mayer-Olkin measure of sampling adequacy for the SAS-M was 0.92, indicating meritoriously that the factor analysis was appropriate. The internal consistency and concurrent validity of the SAS-M were verified (Cronbach’s alpha = 0.94). All of the subscales of the SAS-M, except for positive anticipation, were significantly related to the Malay version of the IAT. Conclusions This study developed the first smart phone addiction scale among medical students. This scale was shown to be reliable and valid in the Malay language.
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The purpose of this study was to assess the influence of the duration of smartphone usage on cervical and lumbar spine flexion angles and reposition error in the cervical spine. The study included 18 healthy smartphone users (7 males and 11 females). We measured the kinematics of the upper and lower cervical and lumbar spine flexion angles and the reposition error of the upper and lower cervical spine after 3 s and 300 s smartphone use in sitting. A paired t-test was used to compare the effects of the duration of smartphone usage on the kinematics of cervical and lumbar spine flexion angles and reposition error. The flexion angles of the lower cervical and lumbar spine and the reposition error in the upper and lower cervical spine were significantly increased after 300 s smartphone of use (p.05). These findings suggest that prolonged use of smartphones can induce changes in cervical and lumbar spine posture and proprioception in the cervical spine.
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Background It is assumed that good postural alignment is associated with the less likelihood of musculoskeletal pain symptoms. Encouraging good sitting postures have not reported consequent musculoskeletal pain reduction in school-based populations, possibly due to a lack of clear understanding of good posture. Therefore this paper describes the variability of postural angles in a cohort of asymptomatic high-school students whilst working on desk-top computers in a school computer classroom and to report on the relationship between the postural angles and age, gender, height, weight and computer use. Methods The baseline data from a 12 month longitudinal study is reported. The study was conducted in South African school computer classrooms. 194 Grade 10 high-school students, from randomly selected high-schools, aged 15–17 years, enrolled in Computer Application Technology for the first time, asymptomatic during the preceding month, and from whom written informed consent were obtained, participated in the study. The 3D Posture Analysis Tool captured five postural angles (head flexion, neck flexion, cranio-cervical angle, trunk flexion and head lateral bend) while the students were working on desk-top computers. Height, weight and computer use were also measured. Individual and combinations of postural angles were analysed. Results 944 Students were screened for eligibility of which the data of 194 students are reported. Trunk flexion was the most variable angle. Increased neck flexion and the combination of increased head flexion, neck flexion and trunk flexion were significantly associated with increased weight and BMI (p = 0.0001). Conclusions High-school students sit with greater ranges of trunk flexion (leaning forward or reclining) when using the classroom computer. Increased weight is significantly associated with increased sagittal plane postural angles.
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The aim of this study was to develop a self-diagnostic scale that could distinguish smartphone addicts based on the Korean self-diagnostic program for Internet addiction (K-scale) and the smartphone's own features. In addition, the reliability and validity of the smartphone addiction scale (SAS) was demonstrated. A total of 197 participants were selected from Nov. 2011 to Jan. 2012 to accomplish a set of questionnaires, including SAS, K-scale, modified Kimberly Young Internet addiction test (Y-scale), visual analogue scale (VAS), and substance dependence and abuse diagnosis of DSM-IV. There were 64 males and 133 females, with ages ranging from 18 to 53 years (M = 26.06; SD = 5.96). Factor analysis, internal-consistency test, t-test, ANOVA, and correlation analysis were conducted to verify the reliability and validity of SAS. Based on the factor analysis results, the subscale "disturbance of reality testing" was removed, and six factors were left. The internal consistency and concurrent validity of SAS were verified (Cronbach's alpha = 0.967). SAS and its subscales were significantly correlated with K-scale and Y-scale. The VAS of each factor also showed a significant correlation with each subscale. In addition, differences were found in the job (p<0.05), education (p<0.05), and self-reported smartphone addiction scores (p<0.001) in SAS. This study developed the first scale of the smartphone addiction aspect of the diagnostic manual. This scale was proven to be relatively reliable and valid.
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To estimate the effects of a relatively protruded head and neck posture on postural balance, in computer based worker. Thirty participants, who work with computers for over 6 hrs per day (Group I), and thirty participants, who rarely work with computers (Group II), were enrolled. The head and neck posture was measured by estimating angles A and B. A being the angle between the tragus of the ear, the lateral canthus of the eye, and horizontal line and B the angle between the C7 spinous process, the tragus of the ear, and the horizontal line. The severity of head protrusion with neck extension was assessed by the subtraction of angle A from angle B. We also measured the center of gravity (COG) and postural balance by using computerized dynamic posturography to determine the effect of computer-based work on postural balance. Results indicated that group I had a relatively more protruded head with extensive neck posture (angle B-A of group I and group II, 28.2±8.3, 32.9±6.0; p<.05). The COG of group I tended more toward the anterior than that of group II. Postural imbalance and impaired ability to regulate movement in forward and backward direction were also found. The results of this study suggest that forward head postures during computer-based work may contribute to some disturbance in the balance of healthy adults. These results could be applied to education programs regarding correct postures when working at a computer for extended periods of time.
Preamble. Billions of people are using cell phone devices on the planet, essentially in poor posture. The purpose of this study is to assess the forces incrementally seen by the cervical spine as the head is tilted forward, into worsening posture. This data is also necessary for cervical spine surgeons to understand in the reconstruction of the neck.
The purpose of this study was to systematically review prospective cohort studies to identify risk factors for the onset of low back pain (LBP) in office workers. Online searches were conducted on PubMed, CINAHL Plus with full text, ScienceDirect, PEDro, ProQuest, and Scopus databases from 1980 to November 2011 using the following keywords: low back pain paired with risk or prognostic factors and office or computer or visual display unit (VDU) or visual display terminal (VDT). The methodological quality of each study was assessed using a 21-item checklist, which was divided into 2 parts: the internal validity (11 items) and descriptive quality (10 items) of studies. Strength of evidence for risk factors associated with the development of nonspecific LBP was assessed by defining 5 levels of evidence based on the number of studies and the quality score of studies. Eighteen full-text articles were identified, and 15 were excluded. A total of 3 articles were judged to meet the selection criteria and were included in the methodological quality assessment. Risk factors were divided into 3 groups: individual, work-related physical, and work-related psychosocial risk factors. There was strong evidence that history of LBP is a predictor of the onset of LBP. Limited evidence was found that the combination of postural risk factors and job strain is associated with the onset of LBP. After review of 3 high-quality prospective studies on the association between risk factors and the onset of nonspecific LBP in office workers, few risk factors were found to predict the onset of LBP in office workers.
The use of handheld smart phones for written communication is becoming ubiquitous in modern society. The relatively small screens found in these devices may necessitate close working distances and small text sizes, which can increase the demands placed on accommodation and vergence. Font size and viewing distance were measured while subjects used handheld electronic devices in two separate trials. In the first study (n=129), subjects were asked to show a typical text message on their own personal phone and to hold the device "as if they were about to read a text message." A second trial was conducted in a similar manner except subjects (n=100) were asked to view a specific web page from the internet. For text messages and internet viewing, the mean font size was 1.1 M (range, 0.7 to 2.1 M) and 0.8 M (range, 0.3 to 1.4 M), respectively. The mean working distance for text messages and internet viewing was 36.2 cm (range, 17.5 to 58.0 cm) and 32.2 cm (range, 19 to 60 cm), respectively. The mean font size for both conditions was comparable with newspaper print, although some subjects viewed text that was considerably smaller. However, the mean working distances were closer than the typical near working distance of 40 cm for adults when viewing hardcopy text. These close distances place increased demands on both accommodation and vergence, which could exacerbate symptoms. Practitioners need to consider the closer distances adopted while viewing material on smart phones when examining patients and prescribing refractive corrections for use at near, as well as when treating patients presenting with asthenopia associated with nearwork.
The study aims were, in a population of university students, staff, and faculty (n = 140), to: 1) determine the distribution of seven measures of mobile device use; 2) determine the distribution of musculoskeletal symptoms of the upper extremity, upper back and neck; and 3) assess the relationship between device use and symptoms. 137 of 140 participants (98%) reported using a mobile device. Most participants (84%) reported pain in at least one body part. Right hand pain was most common at the base of the thumb. Significant associations found included time spent internet browsing and pain in the base of the right thumb (odds ratio 2.21, 95% confidence interval 1.02-4.78), and total time spent using a mobile device and pain in the right shoulder (2.55, 1.25-5.21) and neck (2.72, 1.24-5.96). Although this research is preliminary, the observed associations, together with the rising use of these devices, raise concern for heavy users.