Abstract
Background: The widespread adoption of smartphones has transformed global communication but raised health concerns like Text Neck Syndrome - a musculoskeletal condition arising from prolonged device use, causing discomfort in the cervical spine. This study investigates its prevalence and associated factors among smartphone users in Jeddah, Saudi Arabia, focusing on usage patterns, symptoms, and awareness.
Methods: This cross-sectional online survey was conducted from June 1 to June 30, 2024. Data on demographics, smartphone habits, symptoms, and Text Neck Syndrome awareness were collected using a structured questionnaire. Statistical analysis involved descriptive statistics and chi-square tests.
Results: The study included 421 participants, predominantly female (279, 66.3%) and Saudi nationals (397, 94.3%). The largest age group was 21-40 years (308, 73.2%), and most were single (251, 59.6%) with a college degree (236, 56.1%). Over 42.0% of participants used smartphones for more than five hours daily, with 39.4% adopting a 30-degree neck posture. The most prevalent symptoms reported were neck pain (272, 64.6%), headaches (203, 48.2%), and shoulder pain (178, 42.3%). Awareness of Text Neck Syndrome was reported by 197 participants (46.8%), but only 60 (14.3%) had been diagnosed. Concerns about long-term complications such as osteoporosis (105, 24.9%) and prolapsed intervertebral disc (120, 28.5%) were expressed. Despite these concerns, 97.9% of participants hesitated to reduce smartphone usage due to reported symptoms.
Conclusion: This study highlights the significant musculoskeletal impact of smartphone use in Jeddah, underscoring the need for interventions promoting ergonomic practices and increasing awareness about associated risks. Public health strategies should focus on promoting ergonomic practices and educating users about preventive measures.
Keywords: saudi arabia, ergonomic practices, shoulder pain, headaches, neck pain, musculoskeletal disorders, smartphone use, text neck syndrome
Introduction
In recent years, the widespread adoption of smartphones has revolutionized communication and access to information globally [1,2]. However, this surge in usage has brought to light a range of health concerns, one of which is Text Neck Syndrome. Text Neck Syndrome refers to a musculoskeletal condition characterized by discomfort and pain in the cervical spine, resulting from prolonged and repetitive use of handheld electronic devices, such as smartphones and tablets [3,4].
The prevalence of Text Neck Syndrome has gained increasing attention as smartphones become indispensable tools in daily life, particularly among younger demographics who are heavy users [5]. The posture adopted during smartphone use is often characterized by prolonged periods of forward head flexion-places excessive strain on the cervical spine. This maladaptive posture not only affects musculoskeletal health but may also lead to a variety of associated symptoms, including neck pain, shoulder pain, upper back pain, headaches, and numbness in the hands and arms [6-8].
Research on Text Neck Syndrome has primarily focused on understanding its prevalence, associated risk factors, and potential long-term consequences. Studies have identified demographic factors, such as age and gender, as well as behavioral factors, such as duration and frequency of smartphone use, as significant contributors to the development and severity of Text Neck Syndrome symptoms [5-9].
Despite the growing recognition of Text Neck Syndrome, there remains a need for further investigation into its epidemiology, risk factors, and management strategies, particularly in diverse populations and cultural contexts. This study aims to contribute to the existing literature by examining the prevalence of Text Neck Syndrome and associated factors among smartphone users in Jeddah, Saudi Arabia. By elucidating these factors, the study seeks to inform targeted interventions and public health strategies aimed at mitigating the impact of smartphone-related musculoskeletal disorders.
Materials and methods
Study design
This cross-sectional study aimed to investigate the prevalence of Text Neck Syndrome and associated factors among smartphone users in Jeddah, Saudi Arabia. The study was designed to collect data through an online survey conducted over one month, from June 1, 2024, to June 30, 2024. This design was chosen for its efficiency in reaching a broad and diverse participant pool within a short period, allowing for the collection of comprehensive data on smartphone usage habits, symptoms, and awareness of Text Neck Syndrome.
Study participants
Participants were recruited using convenience sampling techniques, primarily through social media platforms and online community groups to maximize reach. Eligible individuals were aged 18 years and above, residing in Jeddah, and regular users of smartphones. To ensure a representative sample, recruitment efforts targeted various demographic groups, including different age ranges, genders, and educational backgrounds. Exclusion criteria included individuals with pre-existing musculoskeletal disorders or those unable to complete the questionnaire independently due to cognitive or physical impairments.
Data collection
Data were collected using a structured questionnaire developed specifically for this study. The questionnaire was informed by existing literature on Text Neck Syndrome and smartphone usage patterns and was culturally adapted to ensure relevance to the Saudi Arabian context. It was distributed electronically via a survey platform, ensuring ease of access for participants. The questionnaire comprised several sections, including demographic information (gender, age, marital status, educational level, and nationality), smartphone usage habits (daily duration of smartphone use and habitual neck posture during use, with specific angles provided for accuracy - 0 degrees, 15 degrees, 30 degrees, 45 degrees, and 60 degrees), symptoms and diagnoses (prevalence of symptoms related to smartphone use, including neck pain, arm pain, headaches, back pain, shoulder pain, hand numbness, and stiff neck; severity of symptoms; and diagnosis of Text Neck Syndrome), awareness and attitudes (awareness of Text Neck Syndrome, perceived causes, and preventive measures, as well as attitudes towards reducing smartphone usage in light of experienced symptoms), and concerns about long-term complications (participants' concerns regarding potential long-term complications associated with prolonged smartphone use, such as osteoporosis and prolapsed intervertebral disc).
Statistical analysis
Descriptive statistics were employed to summarize the data, with frequencies and percentages used for categorical variables. Chi-square tests were conducted to explore associations between demographic factors, smartphone usage habits, and the prevalence of Text Neck Syndrome symptoms. All statistical analyses were performed using Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 26.0, Armonk, NY). A p-value of <0.05 was considered statistically significant.
Results
Demographic characteristics of study participants
The study included a total of 421 participants from Jeddah, Saudi Arabia. Table 1 summarizes the demographic characteristics of the study participants. The majority were female (279, 66.3%) and Saudi nationals (397, 94.3%). The largest age group was 21-40 years (308, 73.2%), and most participants were single (251, 59.6%). Educational attainment varied, with a significant proportion having a college degree (236, 56.1%).
Table 1. Demographic characteristics of study participants (N = 421).
Data are represented using frequencies and percentages.
| Characteristics | Frequency | Percent | |
| Gender | Male | 142 | 33.7 |
| Female | 279 | 66.3 | |
| Age Groups | ≤20 years | 35 | 8.3 |
| 21-40 years | 308 | 73.2 | |
| 41-60 years | 73 | 17.3 | |
| 61+ years | 5 | 1.2 | |
| Marital Status | Single | 251 | 59.6 |
| Married | 141 | 33.5 | |
| Divorced | 23 | 5.5 | |
| Widowed | 6 | 1.4 | |
| Education Level | Primary education | 1 | 0.2 |
| Intermediate education | 11 | 2.6 | |
| High school diploma | 142 | 33.7 | |
| College degree | 236 | 56.1 | |
| Higher studies | 31 | 7.4 | |
| Nationality | Saudi | 397 | 94.3 |
| Non-Saudi | 24 | 5.7 | |
Smartphone use and neck posture habits
Table 2 presents participants' habits regarding smartphone use and neck posture. A substantial number reported using smartphones for more than five hours daily (177, 42.0%). The most common neck posture during smartphone use was at 30 degrees (166, 39.4%).
Table 2. Smartphone use and neck posture habits among participants (N = 421).
Data are represented using frequencies and percentages.
| Characteristics | Frequency | Percent | |
| Smartphone Use Daily | Less than 2 hours | 8 | 1.9 |
| 2-3 hours | 83 | 19.7 | |
| 3-5 hours | 153 | 36.3 | |
| More than 5 hours | 177 | 42.0 | |
| Neck Position | 0 degrees | 10 | 2.4 |
| 15 degrees | 70 | 16.6 | |
| 30 degrees | 166 | 39.4 | |
| 45 degrees | 133 | 31.6 | |
| 60 degrees | 42 | 10.0 | |
| Awareness of Smartphone Harms | No | 35 | 8.3 |
| Yes | 386 | 91.7 | |
Reported symptoms and diagnoses
Table 3 outlines participants' reported symptoms and diagnoses. The most prevalent symptoms were neck pain (272, 64.6%), headaches (203, 48.2%), and shoulder pain (178, 42.3%). The severity of reported symptoms ranged from no pain (134, 31.8%) to severe pain-limiting activities (36, 8.6%).
Table 3. Prevalence and severity of reported symptoms (N = 421).
Data are represented using frequencies and percentages.
| Characteristics | Frequency | Percent | |
| Symptoms of Smartphone Use | Experienced neck pain | 272 | 64.6 |
| Experienced arm pain | 163 | 38.7 | |
| Experienced headache | 203 | 48.2 | |
| Experienced back pain | 158 | 37.5 | |
| Experienced shoulder pain | 178 | 42.3 | |
| Experienced hand numbness | 139 | 33.0 | |
| Experienced stiff neck | 114 | 27.1 | |
| Text Neck Syndrome | Heard of Text Neck Syndrome | 197 | 46.8 |
| Diagnosed with text neck | 60 | 14.3 | |
| Severity of Neck Pain | No pain | 134 | 31.8 |
| Mild pain with movement | 89 | 21.1 | |
| Mild continuous pain | 130 | 30.9 | |
| Severe pain | 36 | 8.6 | |
| Very severe pain | 24 | 5.7 | |
| Intolerable pain | 8 | 1.9 | |
| Headaches Using Smartphone | No headache | 157 | 37.3 |
| Mild headache | 162 | 38.5 | |
| Moderate headache | 75 | 17.8 | |
| Severe headache | 22 | 5.2 | |
| Persistent and severe headache | 5 | 1.2 | |
Awareness and attitudes towards Text Neck Syndrome
Table 4 details participants' awareness and attitudes towards Text Neck Syndrome. Nearly half of the participants (197, 46.8%) were aware of the syndrome, while a smaller proportion (60, 14.3%) reported being diagnosed with it. Multiple factors were believed to contribute to Text Neck Syndrome, including mobile device use (71, 16.9%) and e-reading devices (38, 9.0%).
Table 4. Awareness and attitudes towards Text Neck Syndrome (N = 421).
| Characteristics | Frequency | Percent | |
| Causes of Text Neck | Personal computer use | 53 | 12.6 |
| Mobile device use | 71 | 16.9 | |
| E-reading devices | 38 | 9.0 | |
| All of the above | 204 | 48.5 | |
| None of the above | 1 | 0.2 | |
| Unsure | 54 | 12.8 | |
| Prevention of Text Neck | No | 29 | 6.9 |
| Yes | 288 | 68.4 | |
| Unsure | 104 | 24.7 | |
| Symptoms of Text Neck | Chronic headaches | 42 | 10.0 |
| Shoulder pain | 31 | 7.4 | |
| Neck pain | 79 | 18.8 | |
| All of the above | 175 | 41.6 | |
| None of the above | 1 | 0.2 | |
| Unsure | 93 | 22.1 | |
Concerns about long-term complications
Regarding participants' concerns about long-term complications associated with smartphone use, a notable percentage expressed concerns over potential complications such as osteoporosis (105, 24.9%) and prolapsed intervertebral disc (120, 28.5%). Despite the reported symptoms and potential complications, the overwhelming majority of participants (412, 97.9%) expressed hesitancy to reduce their smartphone usage.
Discussion
This study investigated the prevalence and factors associated with Text Neck Syndrome among smartphone users in Jeddah, Saudi Arabia. The findings underscore significant insights into the musculoskeletal health implications stemming from prolonged smartphone use in this population. A notable proportion of participants reported experiencing symptoms commonly associated with Text Neck Syndrome, such as neck pain, shoulder discomfort, and headaches. These symptoms were prevalent among individuals who reported using smartphones for extended periods daily, exceeding five hours. This aligns with global concerns regarding the ergonomic impact of prolonged screen time on musculoskeletal health [10-13].
While a majority of participants demonstrated awareness of Text Neck Syndrome, understanding of preventive measures was limited. This knowledge gap underscores the importance of educational initiatives aimed at promoting ergonomic smartphone use practices to mitigate the onset of related symptoms. Specifically, interventions focusing on posture correction, regular breaks, and ergonomic accessories could potentially reduce the prevalence and severity of Text Neck Syndrome among smartphone users [10,14].
Our findings are consistent with existing research highlighting the widespread prevalence of Text Neck Syndrome symptoms among smartphone users globally. Similar studies have identified usage patterns and symptom prevalence comparable to those observed in our study population, reinforcing the global nature of this health issue [12-16].
Future research employing longitudinal designs and more diverse sampling methods could provide deeper insights into the progression and impact of Text Neck Syndrome over time. Longitudinal studies would also help in understanding how prolonged smartphone use contributes to the development of chronic musculoskeletal conditions beyond the immediate symptoms reported.
Several limitations should be considered when interpreting our findings. Firstly, the study employed convenience sampling, which may limit the generalizability of results to the broader population of smartphone users in Jeddah. The sample predominantly comprised regular smartphone users who may be more likely to experience symptoms related to Text Neck Syndrome, potentially overestimating prevalence rates compared to the general population. Secondly, the reliance on self-reported data introduces the possibility of recall bias and subjective interpretation of symptoms, despite efforts to standardize data collection through a structured questionnaire. Additionally, the cross-sectional design inherently restricts our ability to establish causal relationships between smartphone usage patterns and the development of musculoskeletal symptoms.
Conclusions
This study provides valuable insights into the prevalence and associated factors of Text Neck Syndrome among smartphone users in Jeddah, Saudi Arabia. The findings underscore the significant burden of musculoskeletal symptoms associated with smartphone use, highlighting the need for public health interventions to promote ergonomic practices and raise awareness about the potential risks of prolonged device use. Future research should focus on longitudinal studies to elucidate the long-term implications of Text Neck Syndrome and evaluate the effectiveness of preventive measures in mitigating its impact on population health. Such efforts are crucial in addressing the growing public health concern posed by excessive smartphone usage and its associated musculoskeletal disorders.
Appendices
Table 5. Survey questionnaire.
| Question Number | Questions | Options |
| Q1 | Gender | Male, Female |
| Q2 | Age Group | ≤20 years, 21-40 years, 41-60 years, 61+ years |
| Q3 | Marital Status | Single, Married, Divorced, Widowed |
| Q4 | Educational Level | Primary education, Intermediate Education, High school diploma, College degree, Higher studies |
| Q5 | Nationality | Saudi, Non-Saudi |
| Q6 | How many hours do you use your smartphone daily? | Less than 2 hours, 2-3 hours, 3-5 hours, More than 5 hours |
| Q7 | What is your habitual neck posture during smartphone use? | 0 degrees, 15 degrees, 30 degrees, 45 degrees, 60 degrees |
| Q8 | Have you experienced any of the following symptoms related to smartphone use? | Neck pain, Arm pain, Headaches, Back pain, Shoulder pain, Hand numbness, Stiff neck |
| Q9 | Have you heard of Text Neck Syndrome? | Yes, No |
| Q10 | Have you ever been diagnosed with Text Neck Syndrome? | Yes, No |
| Q11 | Are you concerned about long-term complications associated with smartphone use? | Yes, No |
| Q12 | Would you consider reducing your smartphone usage if you experience symptoms related to Text Neck Syndrome? | Yes, No |
Disclosures
Human subjects: Consent was obtained or waived by all participants in this study. MOH Ethics Committee issued approval 2024-110. The study adhered to the ethical principles outlined in the Declaration of Helsinki. Informed consent was obtained from all participants before their inclusion in the study.
Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.
Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following:
Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work.
Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work.
Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.
Author Contributions
Concept and design: Ibrahim Hakami, Mohammed Hadadi, Riyadh Alzahrani, Khalid Alsaedi, Faisal Aljadani, Najlaa Ali, Mohammed Khan, Wasan Aleqbali, Reem Hadadi, Ghena Natto
Acquisition, analysis, or interpretation of data: Ibrahim Hakami, Abdulhai Sherwani, Riyadh Alzahrani, Abdullah Albukhari, Yazan Omar, Khalid Alsaedi, Faisal Aljadani, Najlaa Ali, Rafal Alasmari, Amar Khan, Wasan Aleqbali, Reem Hadadi
Drafting of the manuscript: Ibrahim Hakami, Abdulhai Sherwani, Mohammed Hadadi, Abdullah Albukhari, Faisal Aljadani, Najlaa Ali, Mohammed Khan, Rafal Alasmari, Reem Hadadi, Ghena Natto
Critical review of the manuscript for important intellectual content: Ibrahim Hakami, Riyadh Alzahrani, Yazan Omar, Khalid Alsaedi, Faisal Aljadani, Najlaa Ali, Rafal Alasmari, Amar Khan, Wasan Aleqbali, Ghena Natto
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