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 Table of Contents  
Year : 2022  |  Volume : 16  |  Issue : 2  |  Page : 72-76

Awareness about text neck syndrome amongst adolescents

1 Department of Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
2 Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
3 Department of Physiotherapy, School of Physiotherapy, Bharati Vidyapeeth, Pune, Maharashtra, India
4 Department of Research Coordinator, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
5 MS Orthopaedics, Sancheti Institute for Orthopaedics and Rehabilitation, Pune, Maharashtra, India

Date of Submission21-Jun-2022
Date of Decision23-Nov-2022
Date of Acceptance30-Nov-2022
Date of Web Publication31-Jan-2023

Correspondence Address:
Dr. Jaspreet Kaur Talwar
Sancheti Healthcare Academy, 11/12 Thube Park, Shivaji Nagar, Pune - 411 005, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/pjiap.pjiap_33_22

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BACKGROUND: Neck pain nowadays is the most prevalent symptom in adolescents due to increased frequency of smartphone usage in improper postures. Consequence of this can lead to complex set of symptoms such as neck pain, upper back pain, tingling numbness in upper limb, thumb pain which is commonly termed as "text neck syndrome" (TNS).
AIMS: To determine the awareness, perception, and knowledge regarding preventive measures, health hazards, and causes of TNS in adolescents.
SETTINGS AND DESIGN: An observational cross-sectional study; subjects were recruited from Pune city during the months of December to March 2022.
SUBJECTS AND METHODS: Examination of 302 adolescents was done using the convenience sampling method. A prevalidated self-made questionnaire for data collection using was administered on online platform.
STATISTICAL ANALYSIS USED: Descriptive statistical method.
RESULTS: 86.4% population use their smartphone for >1 h/day. 67.2% have heard, 32.8% have never heard about TNS. 47.70% population is aware about all the mentioned causes. 20.50% population is aware about holding smartphones at eye level. Preference of only 11.60% of adolescents is fingers for texting on smartphones 67.2% who have heard about TNS, 58.30% are aware about preventive measures.
CONCLUSIONS: The awareness, knowledge, and perception regarding causes, health hazards of TNS is good. There is a lack of knowledge about preventive measures; hence, the practice of the same is poor. There is a need to create the awareness regarding text neck in adolescents in terms of preventive measures.

Keywords: Adolescents, awareness, neck pain, smartphones, text neck syndrome

How to cite this article:
Rathi P, Talwar JK, Athavale N, Dabadghav R, Shyam A, Sancheti P. Awareness about text neck syndrome amongst adolescents. Physiother - J Indian Assoc Physiother 2022;16:72-6

How to cite this URL:
Rathi P, Talwar JK, Athavale N, Dabadghav R, Shyam A, Sancheti P. Awareness about text neck syndrome amongst adolescents. Physiother - J Indian Assoc Physiother [serial online] 2022 [cited 2023 Jun 5];16:72-6. Available from: https://www.pjiap.org/text.asp?2022/16/2/72/368877

  Introduction Top

Text neck syndrome (TNS) or "text neck," or "turtle neck posture," has been described as repeated stress injury and pain as a consequence of frequent forward and downward flexion of head while watching or texting on handheld devices for long periods of time.[1],[2] A 21st century syndrome, text neck was introduced by a US chiropractor Dr. Dean L. Fishman.[3]

WHO Global Burden of Disease revealed neck pain as 8th ranked disability for 15–19 year olds which is higher than other well-known adolescent health problems.[4] Approximately adolescents spend a minimum of 5–7 h a day on smartphones with heads flexed forward to read and text.[4] During texting when head is flexed at 15°, the force on the neck surge to 27 pounds, at 30° 40 pounds, at 45° 49 pounds and at 60° 60 pounds.[5],[6]

"Text neck" may lead to early spinal degeneration, arthritis, spinal curve flattening, spinal misalignment, spinal compression, disc herniation, premature wear, upper quadrant musculoskeletal pain, etc.[4],[7],[8],[9] Prolonged sitting can precipitate wrong postures and weight gain which can consequently cause an increase in the problems of suboptimal posture in children and adolescents.[4]

The study is aimed at determining the awareness, perception, and knowledge regarding preventive measures, health hazards, and causes of TNS in adolescents. The use of mobile phones and laptops in nonergonomic positions leads to the need. Children are at greater risk because their heads are larger in relation to their body size as compared to adults. Increased dependency of the adolescent population on phones leading to serious musculoskeletal problems such as neck, back, shoulder and thumb pain, headache, postural changes in spine in the long term. Epidemiological literature on musculoskeletal pain in adolescents is less in contrast to adults.

  Subjects and Methods Top

It is an observational cross-sectional study in which 302 subjects were recruited through the convenience sampling method. Subjects were recruited from Pune city during the months of December to March 2022. Study included both male and female students, subjects using smartphones, age group of 13–17 years, smartphone usage one or more than 1 h per day and subjects who understand and fill the questionnaire in English. Self-made questionnaire was formulated by seeking information from previous published studies and modified as per the need of the current study. Panel of experts validated the self-made questionnaire and provided the required corrections. As per the feedback received, the final modified version of the questionnaire was then distributed to subjects. Procedure followed during the study was ethical committee approval followed by the data collection on an online platform using a validated self-made questionnaire. Questionnaire distributed included two sections - Section A with socio demographic data such as age, gender, current education details, name, E-mail id of the participants and Section B was divided into three subparts – (1) awareness about TNS, its causes, and health hazards; (2) knowledge about preventive measures; and (3) preferred treatment techniques. Participants were allowed to pick more than one option in few questions of the questionnaire Descriptive statistical method is used for analyzing the study data. The purpose and procedure of study were explained to the participants. The consent for participation in the study was taken online on voluntary basis based on the information provided prior to the Google forms.

  Results Top

Demographic details of participants

The total number of 302 adolescents participated in the study, with a mean age of 15.8 ± 1.39 years. 56% were female and 44% were male. 53.6% are school and 46.4% are college adolescents [Figure 1]. [Figure 1] represents the age distribution of the subjects participated in the study.
Figure 1: Age distribution

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Awareness regarding syndrome

[Figure 2] represents if they have heard about TNS, if yes then where have they heard from. Out of 67.2% of subjects who have heard about TNS, 47.70% are aware about causes of TNS [Figure 3] that represents the awareness about health hazards of excessive smartphone usage.
Figure 2: Have you heard about text neck syndrome, if yes then where have you heard from?

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Figure 3: Do you think excessive usage of smartphones can cause the following hazard?

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Knowledge about preventive measures

[Figure 4] shows how many hours does an adolescent spend time on their smartphones everyday other than calls daily [Figure 5]. Where do they prefer to hold a smartphone while using it? [Figure 6] How often do they use fingers to text and swipe rather than thumb? [Figure 7]. Awareness about holding smart devices at eye level with a minimum distance of 18–25 inches between head and phone [Figure 8]. Are you aware of smartphone height adjusters (e.g. foldable mobile stands, desk phone holders, etc.)?
Figure 4: How many hours do you spend on your smartphones everyday other than calls?

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Figure 5: Where do you prefer to hold your smartphone while using it?

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Figure 6: How often do you use your finger to text and swipe rather than your thumb?

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Figure 7: Are you aware that smart devices should be held at eye level with a minimum distance of 18–25 inches between head and phone?

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Figure 8: Are you aware of smartphone height adjusters (e.g. foldable mobile stands, desk phone holders, etc.)?

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Out of 67.2% who have heard about TNS 58.30% are aware that taking frequent breaks and minimising excessive usage of smartphones in one position.

Preferred treatment technique

Which pain relieving methods do you prefer if you have neck pain after using smartphones? [Figure 9].
Figure 9: Which pain relieving methods do you prefer if you have neck pain after using smartphones?

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  Discussion Top

Musculoskeletal pain related to TNS is nowadays more common in teenagers. Approximation is that about 75% of the world's population is hunched over their handheld devices for hours daily with their head in a forward flexed position.[4] Shah and Sheth reported adolescents spending more than 1 h of constant smartphone use are prone to development of syndrome.[10] Results in the current study have shown 33.10% of subjects spent an average time of 4–6 h daily on smartphones which is similar to a previous study by David et al. that shows spent an average time of 5–7 h daily on smartphones.[4]

Harrison et al. found that the compressive load on the cervical discs was 10 kg greater in the neck-forward flexed position than in neck in neutral position.[11] The weight of the head on the spine gradually escalates with increase in degree of cervical spine flexion and the musculoskeletal effects gradually increase by varying the degrees of neck flexion.[4] A full-grown head weighs almost 5 kg in the neutral position. A study conducted by David et al. demonstrates that all participants (100%) presented a strong flexion of the neck (≥45°) during the daily activities.[4] The current study shows that 49.30% of the population hold their smart phones at chest level where usually the neck flexion angle is ≥30° and the amount of load on cervical spine is around 18.14 kg; hence, this signifies that awareness and practice regarding holding smartphones at proper level is poor.

Repeated injury to coordinated network of nerves, muscles, ligaments, and bones of cervical spine can lead to irritation of nerve roots, inflammation of neck ligaments, and permanent alteration in spinal curvatures.[12] There was a high prevalence of neck and shoulder pain in cross-sectional study conducted in Thai school-age adolescents.[4] A study by Fares et al. also reported that all patients, i.e., (100% of the sample), a cervical neck pain irradiated to the back and the shoulders.[13] Eighty-eight percent subjects of the current study agrees that neck pain can occur as prevalent symptom of TNS.

Repetitive typing with thumb and fingers are all risk factors to develop musculoskeletal disorder related first carpometacarpal joint. The termed coined is "SMS thumb" in which static loading and end range motion of thumb leads to overuse of ligaments and muscles which likely results in metacarpophalangeal joint (MCP) degenerative changes, tendinitis, de quervain's syndrome, and triggers in snuff box muscles.[10],[14] 88.4% of subjects use their thumb and only 11.60% use fingers for typing and texting on their handheld devices thus impacting the thumb for overuse syndrome.

A Swedish study found a 48% incidence of headache among schoolchildren aged 7–18 years.[8] 88.08% of the population of this study complains of eye strain and headache due to prolonged usage of smartphones.

The prevalence of musculoskeletal conditions in childhood and adolescence is increasing rapidly nowadays. It is important to inspect the condition as soon as possible in order to provide the most effective treatment techniques. The best possible means of treating TNS is to take preventive measures.[4] Hence, concluding the current study represents that awareness, knowledge, and perception regarding the causes and health hazards is good but there is a lack of knowledge about preventive measures, and hence, the practice of the same is poor. It is essential to take into consideration at very early onset of symptoms because if not treated effectively can lead to chronic complications at later stages of life. This supports the need to create the awareness campaigns, public health educational programmes in the community regarding primary prevention of syndrome.

Study limitations

The study was performed with a smaller population due to time limitation.

The study did not include adolescents who don't understand English.

Future scope

The prevalence of TNS among adolescents can be conducted in future studies. Further studies can be done on a large scale with larger sample size in multi centred settings for extensive studies for generalized results representing the whole population.

Studies on musculoskeletal pain evaluation and neck syndrome are still lesser in the adolescent population.

Future study can be interview based and questionnaires can be given in different languages.

Clinical implications

Prevention is always better than cure; hence, the role of physiotherapists is to create the awareness and spread knowledge in school and colleges at earliest to prevent this technology-induced musculoskeletal disorder. Proper patient education regarding the preventive measures of TNS and proper ergonomics of smartphone usage.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Vate Lan P. Text neck epidemic: A growing problem for smartphone users in Thailand. Int J Comput Internet Manage 2015;23:1-55.  Back to cited text no. 1
Khan FA, Waqar A, Niazi SN. Text Neck syndrome among students of a medical and dental college in Lahore. J Sharif Med Dent Coll 2020;6:5-8.  Back to cited text no. 2
Khattak S, Gul M, Kakar HA, Ullah G, Rahman M. Prevalence and awareness of text neck syndrome & addiction to smartphones in Doctor of physical therapy students of Peshawar. Ann Allied Health Sci 2020;6:32-7.  Back to cited text no. 3
David D, Giannini C, Chiarelli F, Mohn A. Text neck syndrome in children and adolescents. Int J Environ Res Public Health 2021;18:1565.  Back to cited text no. 4
Al-Gharabawi B. Text neck syndrome: A new concern for physical therapists worldwide. EC Orthopaed 2017;8:89-91.  Back to cited text no. 5
Kamalakannan M, Rakshana R. Estimation and prevention of text neck syndrome among smartphone users. Biomedicine 2020;40:372-6.  Back to cited text no. 6
Thiyagarajan S, The oxford college of physiotherapy, Jeewan Sathi colony, phase 1, J.P. Nagar, Bengaluru, Karnataka-560078, Telegbal SV, the oxford college of physiotherapy, Bangalore. Text neck: Is it a new term for physiotherapists. Indian J Med Health Sci 2015;2:119-21.  Back to cited text no. 7
Samani PP, Athavale NA, Shyam A, Sancheti PK. Awareness of text neck syndrome in the young-adult population. Int J Community Med Public Health 2018;5:1-5.  Back to cited text no. 8
AlZarea BK, Patil SR. Mobile phone head and neck pain syndrome: Proposal of a new entity. Oral Health Dent Manage 2015;251:63-3.  Back to cited text no. 9
Shah PP, Sheth MS. Correlation of smartphone use addiction with text neck syndrome and SMS thumb in physiotherapy students. Int J Community Med Public Health 2018;5:2512-6.  Back to cited text no. 10
Harrison DD, Harrison SO, Croft AC. 33 Sitting biomechanics part I: Review of the literature. J Manipulative 34 Physiol Ther 1999;22:594-609.  Back to cited text no. 11
Neupane S, Ali UI, Mathew A. Text neck syndrome-systematic review. Imp J Interdiscip Res 2017;3:141-8.  Back to cited text no. 12
Fares J, Fares MY, Fares Y. Musculoskeletal neck pain in children and adolescents: Risk factors and complications. Surg Neurol Int 2017;8:72.  Back to cited text no. 13
  [Full text]  
Ahmed S, Akter R, Pokhrel N, Samuel AJ. Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: A cross-sectional survey study. J Public Health (Berl) Theory Pract 2021;29:411-6.  Back to cited text no. 14


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]


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