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Defining text neck: a scoping review

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Abstract

Background

Text neck is regarded as a global epidemic. Yet, there is a lack of consensus concerning the definitions of text neck which challenges researchers and clinicians alike.

Purpose

To investigate how text neck is defined in peer-reviewed articles.

Methods

We conducted a scoping review to identify all articles using the terms “text neck” or “tech neck.” Embase, Medline, CINAHL, PubMed and Web of Science were searched from inception to 30 April 2022. We followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMAScR) guidelines. No limitation was applied for language or study design. Data extraction included study characteristics and the primary outcome relating to text neck definitions.

Results

Forty-one articles were included. Text neck definitions varied across studies. The most frequent components of definitions were grouped into five basis for definition: Posture (n = 38; 92.7%), with qualifying adjectives meaning incorrect posture (n = 23; 56.1%) and posture without a qualifying adjective (n = 15; 36.6%); Overuse (n = 26; 63.4%); Mechanical stress or tensions (n = 17; 41.4%); Musculoskeletal symptoms (n = 15; 36.6%) and; Tissue damage (n = 7; 17.1%).

Conclusion

This study showed that posture is the defining characteristic of text neck in the academic literature. For research purposes, it seems that text neck is a habit of texting on the smartphone in a flexed neck position. Since there is no scientific evidence linking text neck with neck pain regardless of the definition used, adjectives like inappropriate or incorrect should be avoided when intended to qualify posture.

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References

  1. Cuellar JM, Lanman TH (2017) “Text neck”: an epidemic of the modern era of cell phones? Spine J 17(6):901–902. https://doi.org/10.1016/j.spinee.2017.03.009

    Article  PubMed  Google Scholar 

  2. Hansraj K (2014) Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int 25:277–279

    PubMed  Google Scholar 

  3. Fishman DD (2023). Available from: https://www.text-neck.com/

  4. Guan X, Fan G, Wu X, Zeng Y, Su H, Gu G et al (2015) Photographic measurement of head and cervical posture when viewing mobile phone: a pilot study. Eur Spine J 24(12):2892–2898. https://doi.org/10.1007/s00586-015-4143-3

    Article  PubMed  Google Scholar 

  5. Lee S, Kang H, Shin G (2015) Head flexion angle while using a smartphone. Ergonomics 58(2):220–226. https://doi.org/10.1080/00140139.2014.967311

    Article  PubMed  Google Scholar 

  6. Meziat-Filho N, Ferreira AS, Nogueira LAC, Reis FJJ (2018) “Text-neck”: an epidemic of the modern era of cell phones? Spine J 18(4):714–715. https://doi.org/10.1016/j.spinee.2017.11.022

    Article  PubMed  Google Scholar 

  7. Bever L (2014) "Text Neck" is becoming as "epidemic" and could wreck your spine. The Washington Post. https://www.washingtonpost.com/news/morning-mix/wp/2014/11/20/text-neck-is-becoming-an-epidemic-and-could-wreck-your-spine/

  8. Khaleeli H (2014) Text Neck: how smartphones are damaging our spines. The Guardian. https://www.theguardian.com/lifeandstyle/shortcuts/2014/nov/24/text-neck-how-smartphones-damaging-our-spines

  9. Wilson J (2012) Your smartphone is a pain in the neck CNNHealth. https://edition.cnn.com/2012/09/20/health/mobile-society-neck-pain/index.html

  10. Occipital Neuralgia: the painful condition caused by your smart phone. BBC News (2015). https://www.bbc.com/news/newsbeat-33195649

  11. Tonsaker T, Bartlett G, Trpkov C (2014) Health information on the Internet: gold mine or minefield? Can Fam Physician 60(5):407–408

    PubMed  PubMed Central  Google Scholar 

  12. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D et al (2018) PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med 169(7):467–473. https://doi.org/10.7326/M18-0850

    Article  PubMed  Google Scholar 

  13. Ahmed S, Akter R, Pokhrel N, Samuel AJ (2021) Prevalence of text neck syndrome and SMS thumb among smartphone users in college-going students: a cross-sectional survey study. J Public Health-Heidelberg 29(2):411–416

    Article  Google Scholar 

  14. Barrett JM, McKinnon C, Callaghan JP (2020) Cervical spine joint loading with neck flexion. Ergonomics 63(1):101–108. https://doi.org/10.1080/00140139.2019.1677944

    Article  PubMed  Google Scholar 

  15. Buabbas AJ, Al-Mass MA, Al-Tawari BA, Buabbas MA (2020) The detrimental impacts of smart technology device overuse among school students in Kuwait: a cross-sectional survey. BMC Pediatr 20(1):524. https://doi.org/10.1186/s12887-020-02417-x

    Article  PubMed  PubMed Central  Google Scholar 

  16. Cheng C-H, Chien A, Hsu W-L, Chen CP-C, Cheng H-YK (2016) Investigation of the differential contributions of superficial and deep muscles on cervical spinal loads with changing head postures. PLoS ONE 11(3):e0150608. https://doi.org/10.1371/journal.pone.0150608

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chu EC (2022) Preventing the progression of text neck in a young man: a case report. Radiol Case Rep 17(3):978–982. https://doi.org/10.1016/j.radcr.2021.12.053

    Article  PubMed  PubMed Central  Google Scholar 

  18. Correia IMT, Ferreira AD, Fernandez J, Reis FJJ, Nogueira LAC, Meziat N (2021) Association between text neck and neck pain in adults. Spine 46(9):571–578. https://doi.org/10.1097/brs.0000000000003854

    Article  PubMed  Google Scholar 

  19. D’Anna C, Schmid M, Conforto S (2021) Linking head and neck posture with muscular activity and perceived discomfort during prolonged smartphone texting. Int J Ind Ergon 83:103134

    Article  Google Scholar 

  20. da Rosa BN, Candotti CT, Pivotto LR, Noll M, Silva MG, Vieira A et al (2022) Back pain and body posture evaluation instrument for children and adolescents (BackPEI-CA): expansion, content validation, and reliability. Int J Environ Res Public Health 19(3):1398. https://doi.org/10.3390/ijerph19031398

    Article  PubMed  PubMed Central  Google Scholar 

  21. Damasceno GM, Ferreira AS, Nogueira LAC, Reis FJJ, Andrade ICS, Meziat-Filho N (2018a) Text neck and neck pain in 18–21-year-old young adults. Eur Spine J 27(6):1249–1254. https://doi.org/10.1007/s00586-017-5444-5

    Article  PubMed  Google Scholar 

  22. Damasceno GM, Ferreira AS, Nogueira LAC, Reis FJJ, Lara RW, Meziat-Filho N (2018b) Reliability of two pragmatic tools for assessing text neck. J Bodyw Mov Ther 22(4):963–967. https://doi.org/10.1016/j.jbmt.2018.01.007

    Article  PubMed  Google Scholar 

  23. David D, Giannini C, Chiarelli F, Mohn A (2021) Text neck syndrome in children and adolescents. Int J Environ Res Public Health 18(4):1565. https://doi.org/10.3390/ijerph18041565

    Article  PubMed  PubMed Central  Google Scholar 

  24. Derakhshanrad N, Yekaninejad MS, Mehrdad R, Saberi H (2021) Neck pain associated with smartphone overuse: cross-sectional report of a cohort study among office workers. Eur Spine J 30(2):461–467. https://doi.org/10.1007/s00586-020-06640-z

    Article  PubMed  Google Scholar 

  25. Fares J, Fares MY, Fares Y (2017) Musculoskeletal neck pain in children and adolescents: risk factors and complications. Surg Neurol Int 8:72. https://doi.org/10.4103/sni.sni_445_16

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fiebert I, Kistner F, Gissendanner C, DaSilva C (2021) Text neck: an adverse postural phenomenon. Work 69(4):1261–1270. https://doi.org/10.3233/WOR-213547

    Article  PubMed  Google Scholar 

  27. Han H, Shin G (2019a) Head flexion angle when web-browsing and texting using a smartphone while walking. Appl Ergon 81:102884. https://doi.org/10.1016/j.apergo.2019.102884

    Article  PubMed  Google Scholar 

  28. Khan AF, Gillani S, Khan AF, Wahid A (2018) Are you suffering pain neck due to smart phone text neck syndrome. Pakistan J Med Health Sci 12(3):1095–1097

    Google Scholar 

  29. Medani KE, Ahmad MS, Sami W, Shaik RA, Mohamed E, Alhammad MA et al (2021) Perspective, awareness, and behaviour towards text-neck among medical students of Majmaah university-a cross sectional study. J Evolut Med Dental Sci-Jemds 10(5):294–298

    Article  Google Scholar 

  30. Merlo S (2020) Surface electrical stimulation for persistent stuttering and concomitant orofacial disorders: a multiple case study. Percept Mot Skills 127(4):698–721. https://doi.org/10.1177/0031512520915027

    Article  PubMed  Google Scholar 

  31. Portelli A, Reid SA (2018) Cervical proprioception in a young population who spend long periods on mobile devices: a 2-group comparative observational study. J Manipulative Physiol Ther 41(2):123–128. https://doi.org/10.1016/j.jmpt.2017.10.004

    Article  PubMed  Google Scholar 

  32. Soyer O, Akarirmak ZU (2020) The effect of postural correction and exercise on neck pains in cell phone users. Turk Osteoporoz Dergisi-Turkish J Osteoporos 26(2):81–91

    Article  Google Scholar 

  33. Varman R, Wang J, Varman A, Li Z, Tang A, Patil Y et al (2022) Comparison of cervical neck strain in common otolaryngology surgeries. Am J Otolaryngol 43(3):103405. https://doi.org/10.1016/j.amjoto.2022.10340510.1016/j.amjoto.2022.103405

    Article  PubMed  Google Scholar 

  34. Yoon W, Choi S, Han H, Shin G (2021) Neck muscular load when using a smartphone while sitting, standing, and walking. Hum Factors 63(5):868–879. https://doi.org/10.1177/0018720820904237

    Article  PubMed  Google Scholar 

  35. Akshaya R, Mohanraj KG (2019) Knowledge, perception, and awareness of text neck syndrome among young adults South Indian population. Drug Invention Today 12(9):1980–1982

    Google Scholar 

  36. Kamalakannan M, Rakshana R, Padma PR (2020) Estimation and prevention of text neck syndrome among smart phone users. Biomedicine (India) 40(3):372–376

    Google Scholar 

  37. Samani PP (2018) Awareness of text neck syndrome in young-adult population. Int J Community Med Public Health 5(8):3335–3339

    Article  Google Scholar 

  38. Shah PP (2018) Correlation of smartphone use addiction with text neck syndrome and SMS thumb in physiotherapy students. Int J Community Med Public Health 5(6):2512–2516

    Article  Google Scholar 

  39. Kuo Y-R, Fang J-J, Wu C-T, Lin R-M, Su P-F, Lin C-L (2019) Analysis of a customized cervical collar to improve neck posture during smartphone usage: a comparative study in healthy subjects. Eur Spine J 28(8):1793–1803. https://doi.org/10.1007/s00586-019-06022-0

    Article  PubMed  Google Scholar 

  40. Giansanti D, Maccioni G (2021a) Health in the palm of your hand—part 2: design and application of an educational module for young people on the risks from smartphone abuse and the opportunities of telemedicine and e-health. mHealth 7:48. https://doi.org/10.21037/mhealth-20-129

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kirupa K, Divya Mary SM, Nithyanisha R, Kumar SN (2020) A study on the effectiveness of scapular retraction exercises on forward head posture. Indian J Public Health Res Dev 11(6):281–286

    Google Scholar 

  42. Resmy V, Priyanka R (2020) Effectiveness of tech neck exercise among adult smartphone user with text neck syndrome. Int J Res Pharm Sci 11(4):21–24

    Article  Google Scholar 

  43. Pekyavas NO, Saygili F, Yuruk ZO, Sahin FN (2021) The effects of exercise and lifestyle modifications on pain ans function in mobile phone users: a randomized controlled study. Acta Medica Mediterranea 37(3):1803–1809

    Google Scholar 

  44. Abbas Q, Alsheddy A (2020) Driver fatigue detection systems using multi-sensors, smartphone, and cloud-based computing platforms: a comparative analysis. Sensors (Basel, Switzerland) 21(1):56. https://doi.org/10.3390/s21010056

    Article  PubMed  Google Scholar 

  45. Giansanti D, Maccioni G (2021b) Health in the palm of your hand-part 1: the risks from smartphone abuse and the role of telemedicine and e-Health. Mhealth 7:49. https://doi.org/10.21037/mhealth-20-150

    Article  PubMed  PubMed Central  Google Scholar 

  46. Yoong NKM, Perring J, Mobbs RJ (2019) Commercial postural devices: a review. Sensors (Basel, Switzerland) 19(23):5128. https://doi.org/10.3390/s19235128

    Article  PubMed  Google Scholar 

  47. Neupane S (2017) Text neck syndrome-systemtic review. Imp J Interdiscip Res (IJIR). 3(7):141–148

    Google Scholar 

  48. Aegerter AM, Deforth M, Johnston V, Ernst MJ, Volken T, Luomajoki H et al (2020) On-site multi-component intervention to improve productivity and reduce the economic and personal burden of neck pain in Swiss office-workers (NEXpro): protocol for a cluster-randomized controlled trial. BMC Musculoskelet Disord 21(1):391. https://doi.org/10.1186/s12891-020-03388-x

    Article  PubMed  PubMed Central  Google Scholar 

  49. Agrawal KS, Singla S, Shrotriya R (2016) “Text-Neck View”: a new photographic tool for assessment of nasal dorsum in crooked noses. Plast Reconstr Surg 138(1):165e-e167. https://doi.org/10.1097/PRS.0000000000002250

    Article  CAS  PubMed  Google Scholar 

  50. Han H, Lee S, Shin G (2019) Naturalistic data collection of head posture during smartphone use. Ergonomics 62(3):444–448. https://doi.org/10.1080/00140139.2018.1544379

    Article  PubMed  Google Scholar 

  51. Lawanont W, Inoue M, Mongkolnam P, Nukoolkit C (2018) Neck posture monitoring system based on image detection and smartphone sensors using the prolonged usage classification concept. IEEJ Trans Electr Electron Eng 13(10):1501–1510

    Article  Google Scholar 

  52. Bertozzi L, Negrini S, Agosto D, Costi S, Guccione AA, Lucarelli P et al (2021) Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: a cross-sectional study. J Bodyw Mov Ther 26:220–226. https://doi.org/10.1016/j.jbmt.2020.09.006

    Article  PubMed  Google Scholar 

  53. Gustafsson E, Thomee S, Grimby-Ekman A, Hagberg M (2017) Texting on mobile phones and musculoskeletal disorders in young adults: a five-year cohort study. Appl Ergon 58:208–214. https://doi.org/10.1016/j.apergo.2016.06.012

    Article  PubMed  Google Scholar 

  54. Przybyla AS, Skrzypiec D, Pollintine P, Dolan P, Adams MA (2007) Strength of the cervical spine in compression and bending. Spine 32(15):1612–1620. https://doi.org/10.1097/brs.0b013e318074c40b

    Article  PubMed  Google Scholar 

  55. Farrell SF, Smith AD, Hancock MJ, Webb AL, Sterling M (2019) Cervical spine findings on MRI in people with neck pain compared with pain-free controls: a systematic review and meta-analysis. J Magn Reson Imaging 49(6):1638–1654. https://doi.org/10.1002/jmri.26567

    Article  PubMed  Google Scholar 

  56. Guo GM, Li J, Diao QX, Zhu TH, Song ZX, Guo YY et al (2018) Cervical lordosis in asymptomatic individuals: a meta-analysis. J Orthop Surg Res 13(1):147. https://doi.org/10.1186/s13018-018-0854-6

    Article  PubMed  PubMed Central  Google Scholar 

  57. Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F (2015) Abnormal findings on magnetic resonance images of the cervical spines in 1211 asymptomatic subjects. Spine (Phila Pa 1976) 40(6):392–8. https://doi.org/10.1097/BRS.0000000000000775

    Article  PubMed  Google Scholar 

  58. Correia IMT, Grasser T, Meziat-Filho N (2022) Letter to the Editor concerning “Neck pain associated with smartphone overuse: cross-sectional report of a cohort study among office workers” by Derakhshanrad N, et al. (Eur Spine J. 2020 doi: 10.1007/s00586-020-06640-z). Eur Spine J 31(10):2824–5. https://doi.org/10.1007/s00586-022-07323-7

    Article  PubMed  Google Scholar 

  59. Kwon M, Kim DJ, Cho H, Yang S (2013) The smartphone addiction scale: development and validation of a short version for adolescents. PLoS ONE 8(12):e83558. https://doi.org/10.1371/journal.pone.0083558

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Kietrys DM, Gerg MJ, Dropkin J, Gold JE (2015) Mobile input device type, texting style and screen size influence upper extremity and trapezius muscle activity, and cervical posture while texting. Appl Ergon 50:98–104. https://doi.org/10.1016/j.apergo.2015.03.003

    Article  PubMed  Google Scholar 

  61. Namwongsa S, Puntumetakul R, Neubert MS, Boucaut R (2019) Effect of neck flexion angles on neck muscle activity among smartphone users with and without neck pain. Ergonomics 62(12):1524–1533. https://doi.org/10.1080/00140139.2019.1661525

    Article  PubMed  Google Scholar 

  62. Gold JE, Driban JB, Thomas N, Chakravarty T, Channell V, Komaroff E (2012) Postures, typing strategies, and gender differences in mobile device usage: an observational study. Appl Ergon 43(2):408–412. https://doi.org/10.1016/j.apergo.2011.06.015

    Article  CAS  PubMed  Google Scholar 

  63. de la Torre-Díez I, López-Coronado M, Vaca C, Aguado JS, de Castro C (2015) Cost-utility and cost-effectiveness studies of telemedicine, electronic, and mobile health systems in the literature: a systematic review. Telemed J E Health 21(2):81–85. https://doi.org/10.1089/tmj.2014.0053

    Article  PubMed  PubMed Central  Google Scholar 

  64. Williams V, Kovarik C (2018) WhatsApp: an innovative tool for dermatology care in limited resource settings. Telemed J E Health 24:464–468

    Article  PubMed  Google Scholar 

  65. Choi JH, Jung MO, Yoo KT (2016) An analysis of the activity and muscle fatigue of the muscles around the neck under the three most frequent postures while using a smartphone. J Phys Ther Sci 28:1660–1664

    Article  PubMed  PubMed Central  Google Scholar 

  66. 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(Pt A):132–142. https://doi.org/10.1016/j.apergo.2016.08.020

    Article  PubMed  Google Scholar 

  67. Berolo S, Wells RP, Amick BC 3rd (2011) Musculoskeletal symptoms among mobile hand-held device users and their relationship to device use: a preliminary study in a Canadian university population. Appl Ergon 42(2):371–378. https://doi.org/10.1016/j.apergo.2010.08.010

    Article  PubMed  Google Scholar 

  68. Vate-U-Lan P (2015) Text neck epidemic: a growing problem for smart phone users in Thailand. https://repository.au.edu/items/d54042fe-830d-402b-a81a-f948909aa600/full

  69. Vijayakumar M, Mujumdar S, Dehadrai A (2018) Assessment of co-morbid factors associated with text-neck syndrome among mobile phone users. IJSRST 4(9):38–46

    Google Scholar 

  70. Zheng F, Gao P, He M, Li M, Wang C, et al. (2014) Association between mobile phone use and inattention in 7102 Chinese adolescents: a population-based cross-sectional study. BMC Public Health 14:1022

    Article  PubMed  PubMed Central  Google Scholar 

  71. Borhany T, Shahid E, Siddique WA, Ali H (2018) Musculoskeletal problems in frequent computer and internet users. J Family Med Prim Care 7(2):337–339. https://doi.org/10.4103/jfmpc.jfmpc_326_17

    Article  PubMed  PubMed Central  Google Scholar 

  72. Kim MS (2015) Influence of neck pain on cervical movement in the sagittal plane during smartphone use. J Phys Ther Sci 27(1):15–17

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  73. Erdinç O, Hot K, Özkaya M (2011) Cross-cultural adaptation, validity and reliability of Cornell Mus-culoskeletal Discomfort Questionnaire (CMDQ) in Turkish language. Work 39(3):251–260

    PubMed  Google Scholar 

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Acknowledgements

This study was supported by the Fundação Carlos Chagas Filho de Apoio à Pesquisa do Estado do Rio de Janeiro (FAPERJ, No. E-26/211.104/2021) and Coordenação de Aperfeiçoamento de Pessoal (CAPES, Finance Code 001; No. 88881.708719/2022-01, and No. 88887.708718/2022-00).

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Grasser, T., Borges Dario, A., Parreira, P.C.S. et al. Defining text neck: a scoping review. Eur Spine J 32, 3463–3484 (2023). https://doi.org/10.1007/s00586-023-07821-2

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