Analysis of a customized cervical collar to improve neck posture during smartphone usage: a comparative study in healthy subjects

  • Yuh-Ruey Kuo
  • Jing-Jing Fang
  • Chi-Tse Wu
  • Ruey-Mo Lin
  • Pei-Fang Su
  • Cheng-Li LinEmail author
Original Article



A slouching posture during smartphone usage increases gravitational loadings on the cervical spine, which may lead to neck pain and degeneration. The objective of the present study was to investigate the head, neck and trunk angles in different smartphone-usage postures, as well as the posture-correction effects and comfort scores of three neck collars.


This was a prospective cohort study in which 41 healthy young subjects aged 18–25 were recruited. The head, neck and trunk angles were measured in all participants during a neutral position and three smartphone-using postures, including sitting with and without back support and standing. The postural correction and comfort scores of three collars (Aspen Vista, Sport-aid and our customized 3D printed collars) were compared.


Smartphone use increased the head and neck flexion angles in all postures, and sitting without back support showed the greatest head and neck flexion angles. The posture-correcting effect of the customized collar was better than the Aspen Vista and Sport-aid collars. In addition, the customized collar was more comfortable to wear than the other two collars in most contact areas.


Smartphone use increased both the head and neck flexion in different postures, and the proposed customized 3D-printed cervical collar significantly reduced the head and neck angles.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Customized 3D printing Cervical orthosis Postures Smartphone use 



The authors would like to acknowledge the funding support from Taiwan Ministry of Science and Technology (MOST 105-2218-E-006-006, MOST 106-3114-E-006-010, MOST 106-2314-B-039 -038).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6022_MOESM1_ESM.pptx (3.7 mb)
Supplementary material 1 (PPTX 377 kb)


  1. 1.
    Xie Y, Szeto G, Dai J (2017) Prevalence and risk factors associated with musculoskeletal complaints among users of mobile handheld devices: a systematic review. Appl Ergon 59:132–142. CrossRefGoogle Scholar
  2. 2.
    Guan X, Fan G, Wu X, Zeng Y, Su H, Gu G, Zhou Q, Gu X, Zhang H, He S (2015) Photographic measurement of head and cervical posture when viewing mobile phone: a pilot study. Eur Spine J 24:2892–2898. CrossRefGoogle Scholar
  3. 3.
    Hansraj KK (2014) Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int 25:277–279Google Scholar
  4. 4.
    Vasavada AN, Nevins DD, Monda SM, Hughes E, Lin DC (2015) Gravitational demand on the neck musculature during tablet computer use. Ergonomics 58:990–1004. CrossRefGoogle Scholar
  5. 5.
    Lee S, Lee D, Park J (2015) Effect of the cervical flexion angle during smart phone use on muscle fatigue of the cervical erector spinae and upper trapezius. J Phys Ther Sci 27:1847–1849. CrossRefGoogle Scholar
  6. 6.
    Fares J, Fares MY, Fares Y (2017) Musculoskeletal neck pain in children and adolescents: risk factors and complications. Surg Neurol Int 8:72. CrossRefGoogle Scholar
  7. 7.
    Falla D, Jull G, Russell T, Vicenzino B, Hodges P (2007) Effect of neck exercise on sitting posture in patients with chronic neck pain. Phys Ther 87:408–417. CrossRefGoogle Scholar
  8. 8.
    Nejati P, Lotfian S, Moezy A, Nejati M (2015) The study of correlation between forward head posture and neck pain in Iranian office workers. Int J Occup Med Environ Health 28:295–303. Google Scholar
  9. 9.
    Kim MS (2015) Influence of neck pain on cervical movement in the sagittal plane during smartphone use. J Phys Ther Sci 27:15–17. CrossRefGoogle Scholar
  10. 10.
    Gustafsson E (2012) Ergonomic recommendations when texting on mobile phones. Work 41(Suppl 1):5705–5706. Google Scholar
  11. 11.
    Administration OSaH (1995) Draft: instructions for completing the risk factor checklistsGoogle Scholar
  12. 12.
    Inc. H (1993) Applied ergonomic training manualGoogle Scholar
  13. 13.
    Yoo IG, Lee J, Jung MY, Yang NY (2011) Neck and shoulder muscle activation in farm workers performing simulated orchard work with and without neck support. Work 40:385–391. Google Scholar
  14. 14.
    Raine S, Twomey LT (1997) Head and shoulder posture variations in 160 asymptomatic women and men. Arch Phys Med Rehabil 78:1215–1223CrossRefGoogle Scholar
  15. 15.
    Yoo WG, Yi CH, Kim MH (2006) Effects of a proximity-sensing feedback chair on head, shoulder, and trunk postures when working at a visual display terminal. J Occup Rehabil 16:631–637. CrossRefGoogle Scholar
  16. 16.
    Yoo WG, An DH (2009) The relationship between the active cervical range of motion and changes in head and neck posture after continuous VDT work. Ind Health 47:183–188. CrossRefGoogle Scholar
  17. 17.
    van Niekerk SM, Louw Q, Vaughan C, Grimmer-Somers K, Schreve K (2008) Photographic measurement of upper-body sitting posture of high school students: a reliability and validity study. BMC Musculoskelet Disord 9:113. CrossRefGoogle Scholar
  18. 18.
    Evans NR, Hooper G, Edwards R, Whatling G, Sparkes V, Holt C, Ahuja S (2013) A 3D motion analysis study comparing the effectiveness of cervical spine orthoses at restricting spinal motion through physiological ranges. Eur Spine J 22:10–15. CrossRefGoogle Scholar
  19. 19.
    Beavis A (1989) Cervical orthoses. Prosthet Orthot Int 13:6–13. Google Scholar
  20. 20.
    Lusskin R, Berger N (1975) Prescription principles. In: Atlas of orthotics: biomechanical principles and application. American Academy of Orthopaedic Surgeons-St Louis, Mosby Co., pp 370–372Google Scholar
  21. 21.
    Powers J, Daniels D, McGuire C, Hilbish C (2006) The incidence of skin breakdown associated with use of cervical collars. J Trauma Nurs 13:198–200CrossRefGoogle Scholar
  22. 22.
    Schneider AM, Hipp JA, Nguyen L, Reitman CA (2007) Reduction in head and intervertebral motion provided by 7 contemporary cervical orthoses in 45 individuals. Spine (Phila Pa 1976). Google Scholar
  23. 23.
    Yoon TL, Cynn HS, Choi SA, Lee JH, Chio BS (2016) Effect of the craniocervical brace on craniocervical angle, thoracic kyphosis angle, and trunk extensor muscle activity during typing in subjects with forward head posture. Work 55:163–169. CrossRefGoogle Scholar
  24. 24.
    Whitcroft KL, Massouh L, Amirfeyz R, Bannister GC (2011) A comparison of neck movement in the soft cervical collar and rigid cervical brace in healthy subjects. J Manip Physiol Ther 34:119–122. CrossRefGoogle Scholar
  25. 25.
    Gao F (2015) Effectiveness of adjustable cervical orthoses and modular cervical thoracic orthoses in restricting neck motion: a comparative in vivo biomechanical study. Spine (Phila Pa 1976). Google Scholar
  26. 26.
    Goutcher CM, Lochhead V (2005) Reduction in mouth opening with semi-rigid cervical collars. Br J Anaesth 95:344–348. CrossRefGoogle Scholar
  27. 27.
    Woo EH, White P, Lai CW (2016) Musculoskeletal impact of the use of various types of electronic devices on university students in Hong Kong: an evaluation by means of self-reported questionnaire. Man Ther 26:47–53. CrossRefGoogle Scholar
  28. 28.
    Straker L, Burgess-Limerick R, Pollock C, Murray K, Netto K, Coleman J, Skoss R (2008) The impact of computer display height and desk design on 3D posture during information technology work by young adults. J Electromyogr Kinesiol 18:336–349. CrossRefGoogle Scholar
  29. 29.
    Langley J, Pancani S, Kilner K, Reed H, Stanton A, Heron N, Judge S, McCarthy A, Baxter S, Mazza C, McDermott CJ (2018) A comfort assessment of existing cervical orthoses. Ergonomics 61:329–338. CrossRefGoogle Scholar
  30. 30.
    Karason S, Reynisson K, Sigvaldason K, Sigurdsson GH (2014) Evaluation of clinical efficacy and safety of cervical trauma collars: differences in immobilization, effect on jugular venous pressure and patient comfort. Scand J Trauma Resusc Emerg Med 22:37. CrossRefGoogle Scholar
  31. 31.
    Ono A, Amano M, Okamura Y, Numazawa T, Ueyama K, Nishikawa S, Toh S (2005) Muscle atrophy after treatment with Halovest. Spine (Phila Pa 1976) 30:E8–E12CrossRefGoogle Scholar
  32. 32.
    Kim HY, Yeun YR, Kim SJ (2016) Preventive effects of stretching and stabilization exercises on muscle fatigue in mobile phone users. J Phys Ther Sci 28:2529–2532. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of MedicineNational Cheng Kung UniversityTainanTaiwan
  2. 2.Department of Mechanical EngineeringNational Cheng Kung UniversityTainanTaiwan
  3. 3.Department of Orthopaedic Surgery, Tainan Municipal An-Nan HospitalChina Medical UniversityTainanTaiwan
  4. 4.Department of StatisticsNational Cheng Kung UniversityTainanTaiwan
  5. 5.Medical Device R & D Core LaboratoryNational Cheng Kung University HospitalTainanTaiwan

Personalised recommendations