ASSOCIATION OF TEXT NECK WITH THE APPEARANCE OF NECK PAIN: SYSTEMATIC REVIEWABSTRACT
Introduction: Currently, Brazil has approximately 464 million electronic devices, referred to as “text neck.” Consequently, the alteration resulting from this term, known as “text neck syndrome,” is an emerging condition related to changes in the head and neck due to mobile devices and computers. This condition is associated with repetitive efforts linked to using these electronic devices. Objective: To conduct a literature review on the influence of “text neck” on the onset of neck pain (cervicalgia).
Methodology: A systematic review was conducted following the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.” From October 2023 to February 2024, the descriptors “neck pain” and “text neck” were used, along with boolean operators. Eligibility criteria included observational studies with a population aged 18 to 65 diagnosed with cervicalgia. The selection process utilized Rayyan QRCI, and a methodological assessment was carried out using Risk of Bias 2.0 (RoB 2.0).
Results: Four articles published between 2018 and 2022 were included in the review. After the methodological procedure, it was observed that all four articles were classified as having a low risk of bias, totaling 1,067 participants.
Conclusion: Therefore, no association was identified between the use of “text neck” and the onset of neck pain. Level of Evidence I; Systematic Review.
Keywords:
Neck pain; Text neck syndrome; Physiotherapy
RESUMO:
Introdução: Atualmente, o Brasil conta com cerca de 464 milhões de aparelhos eletrônicos, denominados como “text neck”. Por conseguinte, a alteração decorrente desse termo, conhecida como “text neck syndrome”, é uma condição emergente que refere-se às alterações na cabeça e no pescoço decorrentes do uso de dispositivos móveis e computadores. Essa condição está relacionada a esforços repetitivos associados ao uso desses aparelhos eletrônicos.
Objetivo: Realizar um levantamento bibliográfico sobre a influência do “text neck” no surgimento de cervicalgias. Metodologia: Foi conduzida uma revisão sistemática, seguindo as diretrizes do Preferred Reporting Items for Systematic Reviews and Meta-Analyses. No período de outubro de 2023 a fevereiro de 2024, foram utilizados os descritores “neck pain” e “text neck”, juntamente com operadores booleanos. Os critérios de elegibilidade abrangeram estudos observacionais com uma população de 18 a 65 anos, diagnosticada com cervicalgia. O processo de seleção foi realizado utilizando o Rayyan QRCI, enquanto a avaliação metodológica foi conduzida através do Risk of Bias 2.0 (RoB 2.0).
Resultados: Quatro artigos, publicados entre 2018 e 2022, foram incorporados à revisão. Após a realização do procedimento metodológico, observou-se que todos os quatro artigos foram classificados como de baixo risco de viés, totalizando 1.067 participantes.
Conclusão: Portanto, não foi identificada associação entre o uso do “text neck” e o surgimento de cervicalgia. Nível de Evidência I; Revisão Sistemática.
Descritores:
Dor no pescoço; Síndrome de pescoço de texto; Fisioterapia
RESUMEN:
Introducción: Brasil cuenta actualmente con cerca de 464 millones de dispositivos electrónicos, conocidos como “text neck”. Conse-cuentemente, la alteración resultante de este término, conocida como “síndrome del cuello de texto”, es una condición emergente que se refiere a alteraciones en la cabeza y el cuello resultantes del uso de dispositivos móviles y ordenadores. Esta afección está relacionada con el esfuerzo repetitivo asociado al uso de estos dispositivos electrónicos.
Objetivo: Realizar una revisión bibliográfica sobre la influencia del “text neck” en la aparición de dolor de cuello. Metodología: Se realizó una revisión sistemática siguiendo las directrices de los Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Desde octubre de 2023 hasta febrero de 2024, se utilizaron los descriptores “neck pain” y “text neck”, junto con operadores booleanos. Los criterios de elegibilidad incluyeron estudios observacionales con una población de entre 18 y 65 años diagnosticada de dolor de cuello. El proceso de selección se llevó a cabo mediante el Rayyan QRCI, mientras que la evaluación metodológica se realizó mediante Risk of Bias 2.0 (RoB 2.0).
Resultados: Se incorporaron a la revision cuatro artículos, publicados entre 2018 y 2022. Tras realizar el procedimiento metodológico, los cuatro artículos fueron clasificados como de bajo riesgo de sesgo, totalizando 1.067 participantes.
Conclusión: Por lo tanto, no se identificó ninguna asociación entre el uso del “text neck” y la aparición de cervicalgia. Nivel de Evidencia I; Revision Sistemática.
Descriptores:
Dolor de cuello; Síndrome del cuello de texto; Fisioterapia
INTRODUCTION
In the current context, cervicalgia is identified as a pathology of relevance to public health, causing referred dysfunctions related to the head, upper limbs, and trunk.1 Furthermore, in the ranking of the main causes of morbidity and global disability, it is classified in fourth place. The onset of neck pain may be associated with risk factors such as daily habits, genetics, trauma, and physical activity practice.2
Neck pain is identified as pain present from the superior nuchal line to the spinous process of the first thoracic vertebra. Furthermore, studies indicate that people who have already shown symptoms of neck pain are predisposed to the persistence of these symptoms, thus becoming a chronic neck pain condition.1
Cervicalgia is not a single condition but a general term for neck pain. A variety of underlying conditions can cause this pain. The most common classifications of cervicalgia are radicular and non-radicular cervical pain, each associated with different causes. The first is related to neurological level damage, such as nerve and ganglion impairment, while the second refers to other tissues, such as muscular, bone, and articular.3
According to the study by Fandim et al.,1 women of all age groups are most affected by this condition, especially in highly developed countries. Furthermore, it is more prevalent in the urban and active population.
However, some epidemiological studies indicate that certain conditions may lead to the onset of neck pain, such as excessive use of mobile devices. Although epidemiology presents more comprehensive studies regarding the pathology of neck pain in adults, recent studies indicate that young people are significantly affected by this condition, surpassing other common health conditions among adolescents.4
An emerging condition that has been gaining attention is “text neck” (“Text Neck Syndrome”); this is the term used for the forward tilt of the head when using mobile devices and personal computers. This adaptation and inadequate posture of the cervical region to send or read text messages causes an alteration in the biomecha-nical base of the neck, thus leading to the appearance of clinical symptoms of cervicalgia.5
Furthermore, with the head’s forward positioning and the gravitational center’s alteration, there will be a mechanical overload on the ligaments and joints of the cervical region, in addition to increasing the demand on the posterior neck muscles. This set of biomechanical changes due to improper posture when using mobile devices is assumed to be an explanation, especially for the increased prevalence of neck pain.6
From this angle, the aim of this work is to answer the following question: is there an influence of “text neck” on the emergence of the pathological condition of cervicalgia?
METHODOLOGY
Type of Study
This is a systematic review study, following the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
Period of conducting the search and Databases
The research was conducted between October 2023 and February 2024, in the Medline (PubMed), Cochrane Wiley, and Virtual Health Library (BVS) databases.
Search Strategy
The main descriptors chosen for research were collected from MeSH and DeCS: neck pain and text neck. They were combined using the boolean operators OR and AND, resulting in a high-sensitivity or systematic search strategy.
#1 “Neck Pain”[Mesh] OR (Neck Pains) OR (Pain, Neck) OR (Pains, Neck) OR (Neck Ache) OR (Ache, Neck) OR (Aches, Neck) OR (Neck Aches) OR (Cervicalgia) OR (Cervicalgias) OR (Cervicodynia) OR (Cervicodynias) OR (Neckache) OR (Neckaches) OR (Cervical Pain) OR (Cervical Pains) OR (Pain, Cervical) OR (Pains, Cervical) OR (Posterior Cervical Pain) OR (Cervical Pain, Posterior) OR (Cervical Pains, Posterior) OR (Pain, Posterior Cervical) OR (Pains, Posterior Cervical) OR (Posterior Cervical Pains) OR (Posterior Neck Pain) OR (Neck Pain, Posterior) OR (Neck Pains, Posterior) OR (Pain, Posterior Neck) OR (Pains, Posterior Neck) OR (Posterior Neck Pains) OR (Anterior Cervical Pain) OR (Anterior Cervical) OR (Pains Cervical Pain) OR (Anterior Cervical Pains) OR (Anterior Pain, Anterior Cervical) OR (Pains, Anterior Cervical) OR (Anterior Neck Pain) OR (Anterior Neck Pains) OR (Neck Pain, Anterior) OR (Neck Pains, Anterior) OR (Pain, Anterior Neck) OR (Pains, Anterior Neck) #2 “Cell Phone”[Mesh] OR (Phone, Cell) OR (Phones, Cell) OR (Cell Phones) OR (Cellular Phone) OR (Cellular Phones) OR (Phone, Cellular) OR (Phones, Cellular) OR (Telephone, Cellular) OR (Cellular Telephone) OR (Cellular Telephones) OR (Telephones, Cellular) OR (Portable Cellular Phone) OR (Cellular Phone, Portable) OR (Cellular Phones, Portable) OR (Portable Cellular Phones) OR (Transportable Cellular Phone) OR (Cellular Phone, Transportable) OR (Cellular Phones, Transportable) OR (Transportable Cellular Phones) OR (Mobile Phone) OR (Mobile Phones) OR (Phone, Mobile) OR (Phones, Mobile) OR (Mobile Telephone) OR (Mobile Telephones) OR (Telephone, Mobile) OR (Telephones, Mobile) OR (Car Phone) OR (Car Phones) OR (Phone, Car) OR (Phones, Car)
Eligibility Criteria
Studies related to the proposed theme, which are observational studies, with individuals aged between 18 and 65 years who were diagnosed with neck pain and identified the use of electronic devices as a responsible factor, were included. In turn, the exclusion criteria were course completion works and expert opinions.
Selection of Articles
After a high-sensitivity search in the databases, the articles were selected through Rayyan QCRI. The journal’s technical reviewers were divided into two stages. The first stage involved two reviewers, and when they disagreed, the article was passed to the senior specialist reviewer in the second stage, who made the final decision on the articles’ selection.
Methodological Quality Assessment
The evaluative sieve was conducted through the Risk of Bias 2.0 (RoB 2.0), an evaluative method of the methodological quality of randomized clinical trials developed by The Cochrane Collaboration in 2016. The RoB 2.0 contains core criteria such as randomization, intervention assignment, adherence to intervention, missing outcome data, outcome measurement, reported outcome selection, and overall risk in its evaluation. These requirements are assessed between high risk of bias visually identified in red, medium risk of bias or some methodological precipitations identified in yellow, and low risk of bias identified in green.
Flowchart
The research included 470 journals found in the previously mentioned databases. After applying the duplicate filter, 232 articles were excluded. Therefore, 238 journals were left for eligibility assessment, in which 229 articles were excluded. Thus, 9 journals advanced to the methodological evaluation (risk of bias). Journals assessed as high risk of bias were excluded, resulting in a total of 4 articles included in the results, as illustrated in Figure 1.
RESULTS
Four (4) articles published between 2018 and 2022 were included in the review. After the methodological procedure and the data distribution presented in the chart, they were analyzed and organized according to the title, year, objective, methodology, methodological evaluation through RoB 2.0, and main considerations.
The studies’ results were divergent on the subject addressed. The articles found had as their main objective to investigate the correlation of text neck with cervical pain. In study 01, text neck was not associated with adults’ prevalence, frequency, or maximum intensity of neck pain. Complementarily, study 02 did not show an association between text neck and neck pain in young people aged 18 to 21.
On the other hand, in study 03, participants with text neck showed greater proprioceptive error during cervical flexion than controls, which may be related to neck pain and the time spent using electronic devices. Corroborating with the data from the previously mentioned study, in study 04, almost half of the participants showed neck disorders, with smartphone addiction and text neck posture being significantly associated with the occurrence of cervical disorders, as shown in Chart 1 below.
The articles were evaluated for methodological quality using RoB 2.0, as shown in Figure 2.
DISCUSSION
The findings found in this review show that there are still contradictions in defining the influence of postural and proprioceptive changes and adaptations in the cervical region with the onset or worsening of the pathological condition of neck pain.
The study by Damasceno et al.,6 aiming to explore the association of neck pain with the use of mobile devices among the age group of 18-21, demonstrates that there is no link between cervical posture and the incidence of neck pain. In a complementary way, Correia et al8 but with the age range of 18-65 and a larger research group, demonstrate that there is no relationship between the “text neck” and the prevalence, incidence, or even the intensity of neck pain.
Furthermore, the study by Ghamkhar and Kahlaee11 analyzed whether the previous cervical spine posture contributed to neck pain and disabilities in the region. However, it was found that this postural change does not influence the onset of neck pain and that factors such as muscle size resistance can become more complex when neck pain is present.
Contrary to the studies above, the study by Portelli and Reid9 was conducted with a young audience of 35 years divided into 2 groups of 22 people who use mobile devices without support for more than 4 hours a day. Furthermore, it was found that the prolonged use of mobile devices causes proprioceptive changes in the cervical spine, which are more relevant for the flexion movement and contribute to greater intensity of pain in the region.
Corroborating with the author’s data above, the study by Siraju-deen et al.10 involved a university audience aged 18-45 during the pandemic. At least half of the surveyed audience showed cervical disorders. In this way, presenting as a result that the posture adopted during the use of mobile devices has been an aggravating factor for episodes of neck pain.
According to the study by Al-Hadidi et al.,12 which also explored the correlation between prolonged phone use and neck pain among university students, considering factors such as gender, age, and the most frequently used cervical positioning by this audience, a positive response was obtained for this relationship between the use of mobile devices and the duration and intensity of neck pain.
This is by the study by Nejati et al.,13 which evaluated the correlation between forward head posture and neck pain among Iranian office workers. It became evident that elevated thoracic and cra-niovertebral angles correlate with the presence of neck pain only in the working position (p< 0.005), that is, employees who had more severe episodes of neck pain exhibited inadequate posture during the work period.
CONCLUSION
With technological advancement and the influence of the digital age, a great dependency on mobile devices has emerged, revisiting the “text neck syndrome”. Some studies correlate the dependency on using these means with the emergence of cervicalgia and proprioceptive changes in the cervical spine. However, there is no association between the use of electronic devices and the onset of neck pain.
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Study conducted by the Faculdade de Ciências da Saúde - FACS/UERN, Rio Grande do Norte, Brazil.
REFERENCES
- 1 Fandim JV, Nitzsche RA, Michaleff Z, Costa LOP, Saragiotto B. The contemporary management of neck pain in adults. Pain Manag. 2021;11(1):75-87.
- 2 Popescu A, Lee H. Neck Pain and Lower Back Pain. Med Clin North Am. 2020;104(2):279-92.
- 3 Cohen SP, Hooten WM. Advances in the diagnosis and management of neck pain. BMJ. 2017;358:j3221.
- 4 David D, Giannini C, Chiarelli F, Mohn A. Text Neck Syndrome in Children and Adolescents. Int J Environ Res Public Health. 2021;18(4):1565-77.
- 5 Tsantili AR, Chrysikos D, Troupis T. Text Neck Syndrome: disentangling a new epidemic. Acta Med Acad. 2022;51(2):123-7.
- 6 Damasceno GM, Ferreira AS, Nogueira LAC, Reis FJJ, Andrade ICS, Meziat-Filho N. Text neck and neck pain in 18-21-year-old young adults. Eur Spine J. 2018;27(6):1249-54.
- 7 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. A declaração PRISMA 2020: diretriz atualizada para relatar revisões sistemáticas. Rev Panam Salud Publica. 2022;46:e112.
- 8 Correia IMT, Ferreira AS, Fernandez J, Reis FJJ, Nogueira LAC, Meziat-Filho N. Association Between Text Neck and Neck Pain in Adults. Spine. 2020;46(9):571-8.
- 9 Portelli A, Reid SA. Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: a 2-group comparative observational study. J Manipulative Physiol Ther. 2018;41(2):123-8.
- 10 Sirajudeen MS, Alzhrani M, Alanazi A, Alqahtani M, Waly M, Unnikrishnan R, 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. 2022;10:e14443.
- 11 Ghamkhar L, Kahlaee AH. Is forward head posture relevant to cervical muscles performance and neck pain? A case-control study. Braz J Phys Ther. 2019;23(4):346-54.
- 12 Al-Hadidi F, Bsisu I, AlRyalat SA, Al-Zu’bi B, Bsisu R, Hamdan M, et al. Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale to evaluate neck pain. PloS One. 2019;14(5):e0217231.
- 13 Nejati P, Lotfian S, Moezy A, Nejati M. The study of correlation between forward head posture and neck pain in Iranian office workers. Int J Occup Med Environ Health. 2015;28(2):295-303.
Edited by
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Reviewed by:
Aluízio Augusto Arantes
