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
high‐resolution 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
(Burgess‐Limerick, 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 (CAMS142–36/37) and written informed consent
was obtained from each participant prior to their participation.
The study had a cross‐sectional design, to measure self‐reported
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.
The SAS is a self‐reporting scale to assess smartphone addiction (Kwon
et al., 2013). It consists of six factors and 33 items, with a six‐point Likert
scale (1: “strongly disagree”to 6: “strongly agree”). The six factors were
daily‐life disturbance, positive anticipation, withdrawal, cyberspace‐ori-
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).
The NDI assessment involves a 10‐item, 50‐point 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,
Musculoskeletal Care 2017; 1–3 Copyright © 2017 John Wiley & Sons, Ltd.wileyonlinelibrary.com/journal/msc 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
pain’and 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 self‐rated 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 p≤0.05.
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 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 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
2ALABDULWAHAB ET AL.
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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/
ALABDULWAHAB ET AL.3