The Effect of Smartphone Usage in Neck Pain at University Students: A Study on Text Neck Posture During Online Learning
DOI:
https://doi.org/10.59994/ajamts.2025.2.18Keywords:
Neck Pain, Text Neck Posture, Online Learning, Smartphone UsageAbstract
This study aimed to investigate the relationship between text neck posture resulting from excessive smartphone use and e-learning, and its impact on the progression of neck pain among university students in Palestine. A descriptive analytical approach was employed using a questionnaire administered to a sample of 153 male and female students in April 2024. The findings revealed a statistically significant association between prolonged use of smart devices and the prevalence of neck pain, with excessive use of smartphones and computers identified as the most influential factor (60%), while poor head posture, particularly forward head inclination, contributed notably to increased pain levels (30%). Although neck pain negatively affected students’ concentration and engagement during online learning sessions, it did not significantly influence their academic performance or overall well-being, highlighting the importance of adopting proper ergonomic practices to mitigate musculoskeletal risks. The originality of this study lies in its integrated examination of text neck posture within the context of e-learning among Palestinian university students, linking behavioral patterns of smart device usage with musculoskeletal health in a contemporary digital learning environment, thereby addressing a notable gap in local empirical research.
References
[1] Z. Mohd Basar, A. N. Mansor, K. A. Jamaludin, and B. S. Alias, “The effectiveness and challenges of online learning for secondary school students: a case study / Zulaikha Mohd Basar … [et al.],” Asian Journal of University Education (AJUE), vol. 17, no. 3, pp. 119–129, 2021, doi: 10.24191/ajue.v17i3.14514.
[2] N. Yusnilita, “The Impact of Online Learning: Studentâ€TMs Views,” ETERNAL (English Teaching Journal), vol. 11, no. 1, May 2020, doi: 10.26877/eternal.v11i1.6069.
[3] M. Daniyal, S. F. Javaid, A. Hassan, and M. A. B. Khan, “The Relationship between Cellphone Usage on the Physical and Mental Wellbeing of University Students: A Cross-Sectional Study,” Int J Environ Res Public Health, vol. 19, no. 15, p. 9352, Jul. 2022, doi: 10.3390/ijerph19159352.
[4] S. Kumari, R. Kumar, and D. Sharma, “Text Neck Syndrome: The Pain of Modern Era,” Int J Health Sci Res, vol. 11, no. 11, pp. 161–165, Nov. 2021, doi: 10.52403/ijhsr.20211121.
[5] K. Iqbal, K. Hafeez, A. Rashad, and A. A. Lodhi, “Prevalence of Neck Pain and its Association with Smartphone Use among University Students,” Journal of Health and Rehabilitation Research, vol. 4, no. 1, pp. 96–101, Jan. 2024, doi: 10.61919/jhrr.v4i1.330.
[6] Z. K. Roesch and P. Tadi, “Anatomy, Head and Neck, Neck,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2025. Accessed: Feb. 16, 2026. [Online]. Available: http://www.ncbi.nlm.nih.gov
[7] B. Ihnatsenka and A. P. Boezaart, “Applied sonoanatomy of the posterior triangle of the neck,” Int J Shoulder Surg, vol. 4, no. 3, pp. 63–74, 2010, doi: 10.4103/0973-6042.76963.
[8] J. Kaiser, V. Reddy, M. Launico, and J. Lugo-Pico, “Anatomy, Head and Neck: Cervical Vertebrae,” StatPearls, Oct. 2023, Accessed: Feb. 16, 2026. [Online]. Available: https://www.statpearls.com/point-of-care/36293
[9] M. Hebbert, “Anatomy of The Street - The Thomas Sharp lecture 2016,” in Presented at: Insight Public Lecture Series, Newcastle, UK. (2016), Newcastle, UK: Insight Public Lecture Series, Mar. 2016. Accessed: Feb. 16, 2026. [Online]. Available: https://campus.recap.ncl.ac.uk
[10] J. D. Nguyen and H. Duong, “Anatomy, Head and Neck, Anterior: Common Carotid Arteries,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2025. Accessed: Feb. 16, 2026. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK546613/
[11] F. K. Banjar and A. M. Wilson, “Anatomy, Head and Neck, Supraclavicular Lymph Node,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2025. Accessed: Feb. 16, 2026. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK544300/
[12] J. H. Lee, K.-L. Cheng, Y. J. Choi, and J. H. Baek, “High-resolution Imaging of Neural Anatomy and Pathology of the Neck,” Korean J Radiol, vol. 18, no. 1, pp. 180–193, 2017, doi: 10.3348/kjr.2017.18.1.180.
[13] J. E. Hoerter and B. C. Patel, “Anatomy, Head and Neck, Platysma,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2025. Accessed: Feb. 16, 2026. [Online]. Available: http://www.ncbi.nlm.nih.gov
[14] B. Bordoni, F. Jozsa, and M. A. Varacallo, “Anatomy, Head and Neck, Sternocleidomastoid Muscle,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2025. Accessed: Feb. 16, 2026. [Online]. Available: http://www.ncbi.nlm.nih.gov
[15] J. Ourieff, B. Scheckel, and A. Agarwal, “Anatomy, Back, Trapezius,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2025. Accessed: Feb. 16, 2026. [Online]. Available: http://www.ncbi.nlm.nih.gov
[16] Y. S. Khan, A. O. Fakoya, and B. Bordoni, “Anatomy, Head and Neck: Suprahyoid Muscle,” in StatPearls, Treasure Island (FL): StatPearls Publishing, 2025. Accessed: Feb. 16, 2026. [Online]. Available: http://www.ncbi.nlm.nih.gov/books/NBK546710/
[17] N. Malkidou, V. Papadopoulos, and A. Fiska, “Anatomical variations of the infrahyoid muscles and ansa cervicalis: a systematic review and an updated classification system for the omohyoid muscle,” Anat Cell Biol, vol. 58, no. 3, pp. 322–333, Sep. 2025, doi: 10.5115/acb.24.307.
[18] I. Fiebert, F. Kistner, C. Gissendanner, and C. DaSilva, “Text neck: An adverse postural phenomenon,” Work, vol. 69, no. 4, pp. 1261–1270, 2021, doi: 10.3233/WOR-213547.
[19] M. F. Maayah, Z. H. Nawasreh, R. A. M. Gaowgzeh, Z. Neamatallah, S. S. Alfawaz, and U. M. Alabasi, “Neck pain associated with smartphone usage among university students,” PLoS One, vol. 18, no. 6, p. e0285451, Jun. 2023, doi: 10.1371/journal.pone.0285451.
[20] D.-D. Zheng, D. Li, J.-X. Cheng, and R.-H. Jin, “The prevalence of neck pain among online learning students: An observational study,” Medicine (Baltimore), vol. 103, no. 32, p. e39264, Aug. 2024, doi: 10.1097/MD.0000000000039264.
[21] S. Kazeminasab et al., “Neck pain: global epidemiology, trends and risk factors,” BMC Musculoskelet Disord, vol. 23, no. 1, p. 26, Jan. 2022, doi: 10.1186/s12891-021-04957-4.
[22] M. H. Alhazmi et al., “The Impact of Neck Pain on Work Productivity and Quality of Life Among Office Workers in Jazan: A Cross-Sectional Study,” Cureus, vol. 16, no. 12, p. e76254, doi: 10.7759/cureus.76254.
[23] S. N. El-Tallawy, R. Nalamasu, G. I. Salem, J. A. K. LeQuang, J. V. Pergolizzi, and P. J. Christo, “Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain,” Pain Ther, vol. 10, no. 1, pp. 181–209, Jun. 2021, doi: 10.1007/s40122-021-00235-2.
[24] R. M. Basuodan, A. F. Alanizy, G. A. Alghulaymish, M. A. Ahmed, S. H. Alnami, and A. Z. Qureshi, “Neck Pain Disability and Smartphone Addiction Among College Students Before and During COVID-19 Confinement: A Pilot Study,” J Allied Health, vol. 52, no. 4, pp. e171–e175, 2023.
[25] S. Hassnain, M. N. Latif, M. H. Arshad, M. A. Adil, and N. Shahid, “Association of Text Neck Pain with prolonged Studying and Excessive Smart Phone Usage Among Medical Students,” Journal of Bahria University Medical and Dental College, vol. 13, no. 01, pp. 29–33, 2023, Accessed: Feb. 17, 2026. [Online]. Available: https://nja.pastic.gov.pk/PJCIS/index.php
[26] M. S. Sirajudeen et al., “Prevalence of text neck posture, smartphone addiction, and its association with neck disorders among university students in the Kingdom of Saudi Arabia during the COVID-19 pandemic,” PeerJ, vol. 10, p. e14443, 2022, doi: 10.7717/peerj.14443.