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| ORIGINAL ARTICLE |
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| Year : 2022 | Volume
: 16
| Issue : 2 | Page : 84-88 |
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Prevalence of musculoskeletal disorders in students aged 13–18 years with the use of smartphones for online classes
Krutika Jatin Shah, Farheen Salim Patel, Rachana P Dabadghav
Department of Community Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, Maharashtra, India
| Date of Submission | 17-Jun-2022 |
| Date of Decision | 25-Jul-2022 |
| Date of Acceptance | 30-Oct-2022 |
| Date of Web Publication | 31-Jan-2023 |
Correspondence Address:
Dr. Farheen Salim Patel
No. 11/12, Thube Park, Shivajinagar, Pune - 411 005, Maharashtra
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/pjiap.pjiap_25_22
CONTEXT: Smartphones are a common gadget used by individuals in day-to-day life for various purposes. Especially in the lockdown period, the use of gadgets increased tremendously for the purpose of attending online classes. Inefficient use of smartphones by students for attending online classes may lead to several long-term musculoskeletal disorders.
AIMS: The aim of this study was to find the prevalence of musculoskeletal disorders with the use of smartphones during online classes.
SETTINGS AND DESIGN: Community setup, cross-sectional Study design.
SUBJECTS AND METHODS: The approval of the Institutional Ethical Committee was obtained. Informed consent was obtained from the participants and a self-made validated questionnaire was circulated to 202 students through online mode.
STATISTICAL ANALYSIS USED: This was a descriptive data analysis.
RESULTS: Two hundred two students participated in the study with a mean age of 15.5 ± 2.58 years. The mean hours of use of smartphones for attending online classes were 4.81 h ± 2.18 h and the mean hours of use of smartphones for other purposes such as gaming and social media was 2.69 h ± 1.79 h. Neck pain showed the most prevalence among other joints which was supported by the finding that 34.74% of students complained of pain in the neck.
CONCLUSIONS: The prevalence of musculoskeletal disorders is common after smartphone use for online classes and was found to be in the neck, shoulder, upper back, and lower back.
Keywords: Musculoskeletal disorders, neck, online classes, smartphone, students
How to cite this article:
Shah KJ, Patel FS, Dabadghav RP. Prevalence of musculoskeletal disorders in students aged 13–18 years with the use of smartphones for online classes. Physiother - J Indian Assoc Physiother 2022;16:84-8 |
How to cite this URL:
Shah KJ, Patel FS, Dabadghav RP. Prevalence of musculoskeletal disorders in students aged 13–18 years with the use of smartphones for online classes. Physiother - J Indian Assoc Physiother [serial online] 2022 [cited 2023 Jun 5];16:84-8. Available from: https://www.pjiap.org/text.asp?2022/16/2/84/368874 |
| Introduction | |  |
During the COVID-19 pandemic, the most evident changes took place in the education system around the world where there was a transition in the mode of education from offline to online courses. Although the mode of education has changed, much emphasis does not seem to be given to the long-term ill effects of using various types of gadgets while doing so. Smartphones are being used since approximately 2 years not only for attending classes but also for reading and studying online material. The study objective is to find out the prevalence of different musculoskeletal disorders associated with smartphone use. Once the knowledge about common musculoskeletal disorders is acquired efforts in the direction of their preventiion can be easily taken.
| Subjects and Methods | | |
Approval from the Institutional Ethical Committee was obtained before conducting the study.
A cross-sectional observational study was conducted via online mode where participants were selected via convenience sampling. The students were selected based on the following inclusion criteria:
- Students in the age group of 13–18 years
- Students attending online classes for the past 1 year
- Students attending online classes on smartphones for more than half an hour.
Exclusion criteria
Students having a diagnosis of any mental illness or disability.
A questionnaire including 10 questions with questions such as time of smartphone use for online classes, time of smartphone use for other purposes such as gaming and social media, total average screen time of students, complaints of pain or discomfort, the severity of pain, amount of breaks taken during the classes, the Nordic musculoskeletal questionnaire was made which was validated by experts in the field for content validity.
Two hundred and two students of age group 13–18 years with a mean age of 15.5 years ± 2.58 years, of which 48.51% were females and 51.48% males participated in the study.
A Google Form link constituting the information and description of the study and a self-made questionnaire was circulated to the subjects. The consent of the participants was obtained before the questionnaire was presented to them (duration of study was 12 months).
Responses were recorded and descriptive data analysis was carried out.
| Results | | |
Two hundred and two students of age group 13–18 years with a mean age of 15.5 years ± 2.58 years, of which 48.51% were females and 51.48% males participated in the study.
The mean hours of use of smartphones for online classes were 4.81 h ± 2.18 h.
The mean hours of use of smartphones for other purposes such as gaming and social media were 2.69 h ± 1.79 h.
Major areas of complaints of ache, pain, discomfort, and numbness during the past 12 months for 34.61% of students were in the neck, followed by the shoulder (14.10%) and upper back (14.10%) [Graph 1].
30.89% of students were not able to carry out normal activities because of trouble in the neck, followed by the shoulder (19.66%) and upper back (15.73%) [Graph 2].
38.92% of students had consulted a physician for complaints of the neck [Graph 3].
34.74% of students complained of trouble in the neck, 20.18% in the shoulder and 13.61% in the upper back during the past 7 days [Graph 4].
44.54% of students preferred to use the smartphone at shoulder level [Graph 5].
| Discussion | | |
This study aimed to find out the prevalence of musculoskeletal disorders in students with the use of smartphones for online classes. The results of the study indicated that the major complaints were centered around the neck, shoulder joint, upper back, and lower back. Smartphones were most commonly used for attending online classes because of their portability and easy availability.[1]
Neck pain and neck disorders showed the most prevalence among all the joints. Neck flexion is the most common posture adopted while using the smartphone. The flexion movement occurs at both the upper cervical spine, which is the atlanto occipital joint and the lower cervical spine, which is from the C3 to C7 vertebrae. Many studies have proved that neck flexion angle, head tilt angle, and forward head shifting were increased during smartphone use.[2],[3],[4],[5] This study also found that the majority of students prefer to use the smartphone at shoulder level which increases the neck flexion angle and hence the stress on the cervical spine. The continuous static postures make the cervical extensor muscles weak. This results in the atrophy of these muscles and eventually causes spasms and tightness, depriving the muscle from oxygen and nutrient-rich blood supply. The tightness and spasms of the muscle can be an important cause of neck pain.[6] A study done by Hansraj on stresses of the cervical spine caused by posture and position of the head suggested that while flexing the neck forward, the weight and the stress of the cervical spine increase tremendously.[7] Deviation from the natural cervical lordosis leads to increased stress on the cervical vertebrae and ligaments. The continuous use of smartphones in awkward positions will cause repetitive microtrauma to the musculoskeletal structures which are caused by the altered length-tension relationship of the muscles. Furthermore, the repetitive tasks may be associated with an overload of low-threshold motor units.[8] The literature reports that there is increased muscle activity noted in the neck extensor muscles, upper trapezius, and erector spinae with smartphone use.[4],[9] These are mainly the postural muscles of the cervical spine, and so, overuse of these muscles will lead to the common complaint of neck pain, which can also be referred down to the shoulder and upper back. The increased muscle work, altered posture, repetitive microtrauma, altered length-tension relationship of muscles together contribute to the altered biomechanics, and thus the pain and musculoskeletal disorder.
Not only posture but also the time of smartphone use has an important influence on neck pain. The neck flexion angle and the forward head tilt increased with the increase in the duration of smartphone use.[2],[3] The explanation for this could be provided by the fact that longer smartphone use altered the motor control of the neck muscles.[10],[11] A study was done by Kim et al. on 18 smartphone users to find out how the time of smartphone use had an effect on cervical and lumbar spine flexion. They measured changes in the upper and lower cervical spine flexion and in the lumbar spine flexion with the use of smartphones for 3 s–300 s in a sitting position. They found that the flexion angle of the upper cervical spine did not increase significantly after 300 s use, but the flexion of the lower cervical and lumbar spine increased after 300 s use.[12] Hence, this study concludes that increased duration of smartphone use will cause an increase in cervical and lumbar spine flexion,[12] which will then increase muscle activity and spasms and hence lead to pain.
A study done in Thailand by Namwongsa et al. reported that people who suffer from musculoskeletal disorders while using smartphones commonly have their lower back flexed, upper back flexed, wrist and hand in the flexed position, elbow in flexion, shoulders in protraction, and neck in flexion.[13] This study also found that the majority of students tend to use their smartphones at shoulder level, which tends to promote the flexed posture. These awkward position adopted over a long period of time places significant stress on the muscles, ligaments, and other soft-tissue structures of all these joints, which have to control the postures over a prolonged period. This causes repetitive microtrauma and also leads to muscle spasms and tightness, which lead to the common complaints of pain and discomfort.
The thumb is another commonly affected joint with smartphone use, as it is used in a variety of planes and for several repetitive motions. The abduction-adduction motion occurs more frequently than the flexion-extension motion while typing or using the smartphone. The repetitive thumb movements causing repetitive microtrauma and excessive use of soft-tissue structures can be an important cause of thumb pain.[14],[15]
A research study suggests that with the use of smartphones, there is an increase in shoulder protraction. This altered position of the scapulae results in dysfunction of the scapulae in the upper limb motion and hence results in difficulty in using that arm and causes shoulder pain because of the poor biomechanics.[16] The study also suggested an increase in thoracic kyphosis after 5 min of smartphone use which corresponded with another study done by Xie et al., and Tsang, which suggests that there is an increase in thoracic kyphosis after 10 min of smartphone use.[17] The closed kinematic chain pattern of the entire spine results in changes in one segment of the spine affecting the other, hence, creating a series of problems with the alteration of one segment. The altered position of the thoracic spine can alter the biomechanics of the lumbar spine hence resulting in upper and lower back pain. The study also shows an increase in pelvic obliquity after smartphone use which can contribute to low back pain.[16]
This study helped to determine the common musculoskeletal disorders, and the most commonly affected areas were found to be the neck, shoulder, upper back, and lower back. The further implications of the study can be to find out the disorders with a specific prolonged time of use or to compare disorders in two or more joints with a specific duration of use. The disorders relationship with different positions of use of the smartphone can also be explored. The study can also be carried out with a different age group of students.
Limitations of the study
The study was based on self-report and not clinical evaluation, and hence, there might be a chance of recall bias on the part of the participants. The complaints of musculoskeletal disorders were not backed up by a clinical diagnosis.
Acknowledgment
I would like to thank my guide and research coordinator for helping me and guiding me throughout the research process. I would also like to thank the participants of the study.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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