Neck and Upper Extremity Musculoskeletal Symptoms Secondary to Maladaptive Postures Caused by Cell Phones and Backpacks in School-Aged Children and Adolescents

Danny G Warda, Uzoma Nwakibu, Ali Nourbakhsh, Danny G Warda, Uzoma Nwakibu, Ali Nourbakhsh

Abstract

Technology is an essential part of our lives. Nowadays, it is almost impossible to leave the house without a cell phone. Despite the wide range of benefits of cell phones and handheld electronic devices, this evolution of technology has not come without a price. The pandemic of cell phone use among children and young adolescents has led to the emergence of a set of musculoskeletal (MSK) symptoms that have not been seen before in this age group. These symptoms can range from neck and shoulder discomfort to pain, peripheral neurological symptoms of the upper extremity, and long-term complications such as disk prolapse and degenerative disk disease of the cervical spine. This clinical presentation is known as "text neck syndrome." In addition to MSK symptoms, text neck syndrome could also include eye and ear symptoms, psychological problems, peripheral neurological symptoms, and poor academic performance. Multiple mechanisms have been discussed by which cell phone use causes MSK symptoms. Maladaptive postures, a decrease in physical activity leading to obesity, and the direct effect of electromagnetic radiation are some of the mechanisms by which long-term use of cell phones leads to the clinical presentation of text neck syndrome and its long-term consequences. The purpose of this article is to review the literature, discuss the epidemiology of cell phone use and MSK symptoms associated with its use in children and adolescents, describe its clinical presentation, explain the pathophysiology behind it, and provide preventative guidelines that can be used by this age group to allow for the continued use of these electronics without harmful effects on their posture and long-term health.

Keywords: backpacks; cell phone; cervical spine; maladaptive postures; musculoskeletal symptoms; school aged children; text neck; upper extremity.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. David D., Giannini C., Chiarelli F., Mohn A. Text Neck Syndrome in Children and Adolescents. Int. J. Environ. Res. Public Health. 2021;18:1565. doi: 10.3390/ijerph18041565.
    1. Poushter J. Smartphone Ownership and Internet Usage Continues to Climb in Emerging Economies. [(accessed on 17 February 2023)]. Available online:
    1. Fiebert I., Kistner F., Gissendanner C., DaSilva C. Text neck: An adverse postural phenomenon. Work. 2021;69:1261–1270. doi: 10.3233/WOR-213547.
    1. Kong Y.S., Kim Y.M., Shim J.-M. The effect of modified cervical exercise on smartphone users with forward head posture. J. Phys. Ther. Sci. 2017;29:328–331. doi: 10.1589/jpts.29.328.
    1. Roberts J.A., Yaya L.H.P., Manolis C. The invisible addiction: Cell-phone activities and addiction among male and female college students. J. Behav. Addict. 2014;3:254–265. doi: 10.1556/JBA.3.2014.015.
    1. Kim H.-J., Kim J.-S. The relationship between smartphone use and subjective musculoskeletal symptoms and university students. J. Phys. Ther. Sci. 2015;27:575–579. doi: 10.1589/jpts.27.575.
    1. Haug S., Castro R.P., Kwon M., Filler A., Kowatsch T., Schaub M.P. Smartphone use and smartphone addiction among young people in Switzerland. J. Behav. Addict. 2015;4:299–307. doi: 10.1556/2006.4.2015.037.
    1. Szeto G.P., Tsang S.M.H., Dai J., Madeleine P. A field study on spinal postures and postural variations during smartphone use among university students. Appl. Ergon. 2020;88:103183. doi: 10.1016/j.apergo.2020.103183.
    1. Mescher M. The moral impact of digital devices. J. Moral Theol. 2020;9:65–93.
    1. Institute for Health Metrics and Evaluation-IHME GBD Compare 2019. [(accessed on 19 November 2022)]. Available online:
    1. Gustafsson E., Thomée S., Grimby-Ekman A., Hagberg M. Texting on mobile phones and musculoskeletal disorders in young adults: A five-year cohort study. Appl. Ergon. 2017;58:208–214. doi: 10.1016/j.apergo.2016.06.012.
    1. Brattberg G. Do pain problems in young school children persist into early adulthood? A 13-year follow-up. Eur. J. Pain. 2004;8:187–199. doi: 10.1016/j.ejpain.2003.08.001.
    1. Guan X., Fan G., Chen Z., Zeng Y., Zhang H., Hu A., Gu G., Wu X., Gu X., He S. Gender difference in mobile phone use and the impact of digital device exposure on neck posture. Ergonomics. 2016;59:1453–1461. doi: 10.1080/00140139.2016.1147614.
    1. Hocking B., Westerman R. Neurological Abnormalities Associated with Mobile Phone Use. Occup. Med. 2000;50:366–368. doi: 10.1093/occmed/50.5.366.
    1. Lee S., Kang H., Shin G. Head flexion angle while using a smartphone. Ergonomics. 2014;58:220–226. doi: 10.1080/00140139.2014.967311.
    1. Yang C.-Y., Wang J.-C. An unusual case of rapidly progressed cervical compression myelopathy caused by overnight inappropriate usage of Smartphone device. J. Clin. Neurosci. 2017;39:82–84. doi: 10.1016/j.jocn.2016.12.050.
    1. Cuéllar J.M., Lanman T.H. “Text neck”: An epidemic of the modern era of cell phones? Spine J. 2017;17:901–902. doi: 10.1016/j.spinee.2017.03.009.
    1. Filho N.M., Ferreira A.S., Nogueira L., Reis F.J.J. “Text-neck”: An epidemic of the modern era of cell phones? Spine J. 2018;18:714–715. doi: 10.1016/j.spinee.2017.11.022.
    1. Gallagher K.M., Jefferson J., Human A., Burruss C. Acute Pain, Neck Extensor Endurance, and Kinematic Changes Resulting from Sustained Neck Flexion during Smartphone Use. IISE Trans. Occup. Ergon. Hum. Factors. 2022;10:21–33. doi: 10.1080/24725838.2021.2011805.
    1. Gustafsson E., Johnson P., Lindegård A., Hagberg M. Technique, muscle activity and kinematic differences in young adults texting on mobile phones. Ergonomics. 2011;54:477–487. doi: 10.1080/00140139.2011.568634.
    1. Zhuang L., Wang L., Xu D., Wang Z., Liang R. Association between excessive smartphone use and cervical disc degeneration in young patients suffering from chronic neck pain. J. Orthop. Sci. 2020;26:110–115. doi: 10.1016/j.jos.2020.02.009.
    1. Öğrenci A., Koban O., Yaman O., Dalbayrak S., Yılmaz M. The Effect of Technological Devices on Cervical Lordosis. Open Access Maced. J. Med. Sci. 2018;6:467–471. doi: 10.3889/oamjms.2018.107.
    1. Cevik S., Kaplan A., Katar S. Correlation of Cervical Spinal Degeneration with Rise in Smartphone Usage Time in Young Adults. Niger. J. Clin. Pract. 2020;23:1748–1752. doi: 10.4103/njcp.njcp_605_19.
    1. Abu El Kasem S.T., Kattabie O.M., Raoof N.A.A., Moustafa I.M. Effect of forward Head Posture on Sensorimotor Integration. Int. J. Physiother. 2017;4:118–125. doi: 10.15621/ijphy/2017/v4i2/141952.
    1. Bueno G.R., Garcia L.F., Bertolini S.M.M.G., Lucena T.F.R. The Head Down Generation: Musculoskeletal Symptoms and the Use of Smartphones Among Young University Students. Telemed. e-Health. 2019;25:1049–1056. doi: 10.1089/tmj.2018.0231.
    1. Gandhi O.P., Morgan L.L., De Salles A.A., Han Y.-Y., Herberman R.B., Davis D.L. Exposure Limits: The underestimation of absorbed cell phone radiation, especially in children. Electromagn. Biol. Med. 2011;31:34–51. doi: 10.3109/15368378.2011.622827.
    1. Page A.S., Cooper A.R., Griew P., Jago R. Children’s Screen Viewing is Related to Psychological Difficulties Irrespective of Physical Activity. Pediatrics. 2010;126:e1011–e1017. doi: 10.1542/peds.2010-1154.
    1. Mößle T., Kleimann M., Rehbein F., Pfeiffer C. Media use and school achievement-boys at risk? Br. J. Dev. Psychol. 2010;28:699–725. doi: 10.1348/026151009X475307.
    1. Al Shahrani E.S., Al Shehri N.A. Association between smartphone use and carpal tunnel syndrome: A case-control study. J. Fam. Med. Prim. Care. 2021;10:2816. doi: 10.4103/jfmpc.jfmpc_2458_20.
    1. Padua L., Coraci D., Erra C., Doneddu P.E., Granata G., Rossini P.M. Prolonged phone-call posture causes changes of ulnar motor nerve conduction across elbow. Clin. Neurophysiol. 2016;127:2728–2732. doi: 10.1016/j.clinph.2016.05.010.
    1. Curtis S. Texting for Long Periods ‘Could Lower Life Expectancy’. [(accessed on 17 November 2022)]. Available online: .
    1. Christofaro D.G.D., De Andrade S.M., Mesas A.E., Fernandes R.A., Farias Junior J.C. Higher screen time is associated with overweight, poor dietary habits and physical inactivity in Brazilian adolescents, mainly among girls. Eur. J. Sport Sci. 2016;16:498–506. doi: 10.1080/17461391.2015.1068868.
    1. Toh S.H., Coenen P., Howie E.K., Straker L.M. The associations of mobile touch screen device use with musculoskeletal symptoms and exposures: A systematic review. PLoS ONE. 2017;12:e0181220. doi: 10.1371/journal.pone.0181220.
    1. Media C.O.C.A., Strasburger V.C., Hogan M.J., Mulligan D.A., Ameenuddin N., Christakis D.A., Cross C., Fagbuyi D.B., Hill D.L., Levine A.E., et al. Children, Adolescents, and the Media. Pediatrics. 2013;132:958–961. doi: 10.1542/peds.2013-2656.
    1. Bozzola E., Spina G., Ruggiero M., Memo L., Agostiniani R., Bozzola M., Corsello G., Villani A. Media devices in pre-school children: The recommendations of the Italian pediatric society. Ital. J. Pediatr. 2018;44:69. doi: 10.1186/s13052-018-0508-7.
    1. Singla D., Veqar Z. Association Between Forward Head, Rounded Shoulders, and Increased Thoracic Kyphosis: A Review of the Literature. J. Chiropr. Med. 2017;16:220–229. doi: 10.1016/j.jcm.2017.03.004.
    1. Haughie L.J., Fiebert I.M., Roach K.E. Relationship of Forward Head Posture and Cervical Backward Bending to Neck Pain. J. Man. Manip. Ther. 2013;3:91–97. doi: 10.1179/jmt.1995.3.3.91.
    1. Lee M.-Y., Lee H.-Y., Yong M.-S. Characteristics of Cervical Position Sense in Subjects with Forward Head Posture. J. Phys. Ther. Sci. 2014;26:1741–1743. doi: 10.1589/jpts.26.1741.
    1. Ha S.-Y., Sung Y.-H. A temporary forward head posture decreases function of cervical proprioception. J. Exerc. Rehabil. 2020;16:168–174. doi: 10.12965/jer.2040106.053.
    1. Hestbaek L., Leboeuf-Yde C., Kyvik K.O., Manniche C. The Course of Low Back Pain From Adolescence to Adulthood: Eight-year follow-up of 9600 twins. Spine. 2006;31:468–472. doi: 10.1097/01.brs.0000199958.04073.d9.
    1. Fares J., Fares Y., Fares M. Musculoskeletal neck pain in children and adolescents: Risk factors and complications. Surg. Neurol. Int. 2017;8:72. doi: 10.4103/sni.sni_445_16.
    1. Albashtawy M., Al Qadire M., Aloush S., Tawalbeh L., AlAzzam M., Suliman M., Batiha A.-M., Alhalaiqa F., Alshakh H., Al-Rahman A.A. Assessment of Headache Among High School Students in Jordan. J. Sch. Nurs. 2017;35:88–95. doi: 10.1177/1059840517734613.
    1. Hung C.-I., Liu C.-Y., Yang C.-H., Wang S.-J. Headache: An important factor associated with muscle soreness/pain at the two-year follow-up point among patients with major depressive disorder. J. Headache Pain. 2016;17:57. doi: 10.1186/s10194-016-0648-3.
    1. Brattberg G. The incidence of back pain and headache among Swedish school children. Qual. Life Res. 1994;3:S27–S31. doi: 10.1007/BF00433372.
    1. Fichtel A., Larsson B. Psychosocial impact of headache and comorbidity with other pains among Swedish school adolescents. Headache. 2002;42:766–775. doi: 10.1046/j.1526-4610.2002.02178.x.
    1. Sundblad G.M.B., Saartok T., Engström L.-M.T. Prevalence and co-occurrence of self-rated pain and perceived health in school-children: Age and gender differences. Eur. J. Pain. 2007;11:171–180. doi: 10.1016/j.ejpain.2006.02.006.
    1. Correctvision the Effects of Texting on Your Eye Health. [(accessed on 17 November 2022)]. Available online:
    1. Hossmann K.-A., Hermann D.M. Effects of electromagnetic radiation of mobile phones on the central nervous system. Bioelectromagnetics. 2002;24:49–62. doi: 10.1002/bem.10068.
    1. Emre M., Cetiner S., Zencir S., Unlukurt I., Kahraman I., Topcu Z. Oxidative Stress and Apoptosis in Relation to Exposure to Magnetic Field. Cell Biochem. Biophys. 2010;59:71–77. doi: 10.1007/s12013-010-9113-0.
    1. Bae W.-S., Lee H.-O., Shin J.-W., Lee K.-C. The effect of middle and lower trapezius strength exercises and levator scapulae and upper trapezius stretching exercises in upper crossed syndrome. J. Phys. Ther. Sci. 2016;28:1636–1639. doi: 10.1589/jpts.28.1636.
    1. Page P. Shoulder muscle imbalance and subacromial impingement syndrome in overhead athletes. Int. J. Sports Phys. Ther. 2011;6:51–58.
    1. Mousavi-Khatir R., Talebian S., Maroufi N., Olyaei G.R. Effect of static neck flexion in cervical flexion-relaxation phenomenon in healthy males and females. J. Bodyw. Mov. Ther. 2015;20:235–242. doi: 10.1016/j.jbmt.2015.07.039.
    1. Hansraj K.K. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg. Technol. Online. 2014;25:277–279.
    1. Nachemson A.L. Disc Pressure Measurements. Spine. 1981;6:93–97. doi: 10.1097/00007632-198101000-00020.
    1. Rusek W., Baran J., Leszczak J., Adamczyk M., Weres A., Baran R., Inglot G., Pop T. The Influence of Body Mass Composition on the Postural Characterization of School-Age Children and Adolescents. BioMed Res. Int. 2018;2018:1–7. doi: 10.1155/2018/9459014.
    1. Colley R.C., Garriguet D., Janssen I., Craig C.L., Clarke J., Tremblay M.S. Physical activity of Canadian children and youth: Accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2011;22:15–23.
    1. The Common Sense Census: Media Use by Kids Age Zero to Eight. [(accessed on 30 November 2022)]. Available online: .
    1. The Common Sense Census: Media Use by Tweens and Teens. 2021. [(accessed on 9 December 2022)]. Available online: .
    1. Vos T., Barber R.M., Bell B., Bertozzi-Villa A., Biryukov S., Bolliger I., Charlson F., Davis A., Degenhardt L., Dicker D., et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;386:743–800. doi: 10.1016/S0140-6736(15)60692-4.
    1. Jones G.T., Silman A.J., Power C., Macfarlane G.J. Are common symptoms in childhood associated with chronic widespread body pain in adulthood?: Results from the 1958 british birth cohort study. Arthritis Rheum. 2007;56:1669–1675. doi: 10.1002/art.22587.
    1. Taylor J.B., Goode A.P., George S., Cook C.E. Incidence and risk factors for first-time incident low back pain: A systematic review and meta-analysis. Spine J. 2014;14:2299–2319. doi: 10.1016/j.spinee.2014.01.026.
    1. Gold J., Driban J., Thomas N., Chakravarty T., Channell V., Komaroff E. Postures, typing strategies, and gender differences in mobile device usage: An observational study. Appl. Ergon. 2012;43:408–412. doi: 10.1016/j.apergo.2011.06.015.
    1. Vikat A., Rimpelä M., Salminen J.J., Rimpelä A., Savolainen A., Virtanen S. Neck or shoulder pain and low back pain in Finnish adolescents. Scand. J. Public Health. 2000;28:164–173. doi: 10.1177/14034948000280030401.
    1. Adamson G., Murphy S., Shevlin M., Buckle P., Stubbs D. Profiling schoolchildren in pain and associated demographic and behavioural factors: A latent class approach. Pain. 2007;129:295–303. doi: 10.1016/j.pain.2006.10.015.
    1. Wedderkopp N., Kjaer P., Hestbaek L., Korsholm L., Leboeuf-Yde C. High-level physical activity in childhood seems to protect against low back pain in early adolescence. Spine J. 2009;9:134–141. doi: 10.1016/j.spinee.2008.02.003.
    1. Ramprasad M., Alias J., Raghuveer A.K. Effect of backpack weight on postural angles in preadolescent children. Indian Pediatr. 2010;47:575–580. doi: 10.1007/s13312-010-0130-2.
    1. Mo S.W., Xu D.-Q., Li J.X., Liu M. Effect of backpack load on the head, cervical spine and shoulder postures in children during gait termination. Ergonomics. 2013;56:1908–1916. doi: 10.1080/00140139.2013.851281.
    1. Kistner F., Fiebert I., Roach K., Moore J. Postural Compensations and Subjective Complaints Due to Backpack Loads and Wear Time in Schoolchildren. Pediatr. Phys. Ther. 2013;25:15–24. doi: 10.1097/PEP.0b013e31827ab2f7.
    1. Cheung C., Shum S., Tang S., Yau P., Chiu T.T. The correlation between craniovertebral angle, backpack weights, and disability due to neck pain in adolescents. J. Back Musculoskelet. Rehabil. 2010;23:129–136. doi: 10.3233/BMR-2010-0259.
    1. Straker L., O’Sullivan P., Smith A., Perry M. Computer Use and Habitual Spinal Posture in Australian Adolescents. Public Health Rep. 2007;122:634–643. doi: 10.1177/003335490712200511.
    1. Carson V., Hunter S., Kuzik N., Gray C.E., Poitras V.J., Chaput J.-P., Saunders T.J., Katzmarzyk P.T., Okely A.D., Gorber S.C., et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: An update. Appl. Physiol. Nutr. Metab. 2016;41:S240–S265. doi: 10.1139/apnm-2015-0630.
    1. Maciałczyk-Paprocka K., Dudzińska J., Witoszyńska B.S., Krzyżaniak A. Incidence of scoliotic posture in school screening of urban children and adolescents: The case of Poznań, Poland. Anthr. Rev. 2018;81:341–350. doi: 10.2478/anre-2018-0030.
    1. LeBlanc A.G., Spence J.C., Carson V., Gorber S.C., Dillman C., Janssen I., Kho M.E., Stearns J.A., Timmons B.W., Tremblay M.S. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years) Appl. Physiol. Nutr. Metab. 2012;37:753–772. doi: 10.1139/h2012-063.
    1. Poitras V.J., Gray C.E., Borghese M.M., Carson V., Chaput J.-P., Janssen I., Katzmarzyk P.T., Pate R.R., Connor Gorber S., Kho M.E., et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl. Physiol. Nutr. Metab. 2016;41:S197–S239. doi: 10.1139/apnm-2015-0663.
    1. Janssen I., LeBlanc A.G. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int. J. Behav. Nutr. Phys. Act. 2010;7:40. doi: 10.1186/1479-5868-7-40.
    1. Fares J., Saadeddin Z., Al Tabosh H., Aridi H., El Mouhayyar C., Koleilat M.K., Chaaya M., El Asmar K. Extracurricular activities associated with stress and burnout in preclinical medical students. J. Epidemiol. Glob. Health. 2015;6:177–185. doi: 10.1016/j.jegh.2015.10.003.
    1. Fares J., Fares Y. The role of yoga in relieving medical student anxiety and stress. N. Am. J. Med. Sci. 2016;8:202–204. doi: 10.4103/1947-2714.179963.
    1. Fares J., Al Tabosh H., Saadeddin Z., El Mouhayyar C., Aridi H. Stress, burnout and coping strategies in preclinical medical students. N. Am. J. Med. Sci. 2016;8:75–81. doi: 10.4103/1947-2714.177299.
    1. Kuo Y.-R., Fang J.-J., Wu C.-T., Lin R.-M., Su P.-F., Lin C.-L. Analysis of a customized cervical collar to improve neck posture during smartphone usage: A comparative study in healthy subjects. Eur. Spine J. 2019;28:1793–1803. doi: 10.1007/s00586-019-06022-0.

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