The modern epidemic—digital era bad posture and its musculoskeletal consequences: A questionnaire-based study

ABSTRACT

Background:

This study evaluates the prevalence and risk of musculoskeletal (MSK) pain among digital gadget users due to poor posture. It examines device usage patterns, posture, and ergonomics to identify risk factors and assess MSK health. Additionally, it explores awareness, psychosocial influences, and potential strategies for mitigating posture-related MSK issues.

Methods:

A cross-sectional online survey was conducted among 300 participants from diverse age groups, genders, and professional backgrounds who consented voluntarily. Responses were collected through social media platforms.

Results:

Data were collected from 300 study participants. The neck was the most common site for MSK pain, followed by back pain, headaches, and shoulder pain. Prolonged screen-based activities, whether for work or leisure, significantly raise the risk of MSK disorders (MSDs) across all age groups. Chronic MSK pain and diminished physical functionality are strongly associated with an increased likelihood of mental health challenges, including fatigue, sleep disturbances, depression, and anxiety.

Conclusion:

MSDs linked to digital device use can be mitigated through frequent breaks, regular exercise, adequate sleep, and stress management. Adopting these measures promotes long-term MSK health and reduces the risk of chronic pain.

Introduction

The widespread use of digital devices has raised concerns about musculoskeletal disorders (MSDs) due to poor posture. Prolonged smartphone and computer use contributes to forward head posture (FHP), leading to conditions like “text neck” and “tablet shoulder”.[1,2] MSDs affect muscles, tendons, and joints, causing pain in the neck, back, shoulders, and hands.[3,4] Poor ergonomics and excessive screen time exacerbate these issues, impacting work-related health.[5,6] Temporomandibular disorders (TMDs) are linked to cervical posture, affecting gait and stability.[7,8]

MSDs are frequently managed in primary care, especially in cases leading to work-related disability. Both physical and psychosocial factors contribute to these conditions, and enhancing primary care physicians’ (PCPs) ability to identify high-risk patients can aid in early intervention, rehabilitation, and prevention.[9]

This study assesses MSD prevalence, posture risks, and awareness to develop strategies for mitigating digital device-related musculoskeletal (MSK) issues.

Methods

A cross-sectional study utilizing a questionnaire comprising close-ended questions was conducted online among individuals from various age groups and professional backgrounds. The study enrolled participants of diverse genders and age ranges, all of whom gave their informed consent. Inclusion criteria were participants using digital gadgets of all age groups and professionals and able to understand English language. Participation was voluntary and devoid of commercial incentives. The questionnaire had seven sections. (1) Demographic information, (2) digital gadget usage, (3) posture and ergonomics, (4) MSK health, (5) awareness and education, (6) psychosocial factors, (7) recommendations and future. The initial four sections, developed by the researchers, focused on providing background information regarding the correlation between device usage and MSK issues. The fifth and sixth sections were structured to assess the awareness level and impact of lifestyle factors contributing to the exacerbation or alleviation of MSK issues. The seventh section was skillfully designed to explore the educational attainment and awareness acquired by participants through this study, as well as their perspectives on recommendations aimed at mitigating MSK issues arising from digital usage. The final questionnaire was sent via social media platforms and response was closed with 300 participants.

The collected data underwent statistical analysis using the Statistical Package for the Social Sciences (SPSS Version 25; Chicago Inc., IL, USA). Specific statistical tests were applied to determine the significance of comparisons. To assess the normality of the data regarding the association of risk factors with the type of gadgets used, the Kolmogorov–Smirnov test was conducted. Results indicated no significant difference, confirming that the data followed a normal distribution.

Variables were compared using percentages and frequencies. Responses to questions were dichotomously categorized. The Chi-square test was utilized to identify significant associations between risk factors and the type of gadgets used. Additionally, linear regression analysis was performed to predict the impact of risk factors. A P < 0.05 was considered statistically significant.

This questionnaire-based study was reviewed by the Institutional Ethics Committee and deemed exempt research under applicable guidelines, so full ethical clearance was not required.

Results

Demographic information

Table 1 shows the results for the demographic profiles. About 300 participants were evaluated, and their age range was 28.5 ± 11.3 years. A definite gender prevalence was observed, with males (67.7%) more than females (32.3%).

Table 1.

Demographic characteristics of the study population

Characteristic	Value
Age (mean±SD)	28.5±11.3 years
Gender, n (%)
Males	203 (67.7)
Females	97 (32.3)

SD=Standard deviation

Digital gadget usage

The study aimed to understand how long individuals have been using digital gadgets, with options ranging from 3 to 5 years to over 50 years. Results showed that the most common duration was 5–10 years, with 44% of participants in this category. Another 38% reported using gadgets for 10–20 years. Additionally, 14% of participants have been using digital gadgets for 3–5 years. The study found that 99% of participants own mobile phones, 70.7% own laptops, 33% own tablets, 30.7% own desktop computers, and 8% own PlayStation. When it comes to regular use, 99.3% use mobile phones, 49.3% use laptops, 19.3% use tablets, 10.3% use desktop computers, and 2.7% use PlayStation [Figure 1]. The study found that 45.3% of participants spend 3–5 h per day using digital gadgets, 29% spend 6–8 h, 13% spend 1–3 h, 9% spend 8–10 h, and 3% spend more than 10 h daily. The study found that 94.3% of participants have a social media account. With the increasing prevalence of social media, 55.7% of participants spend 1–3 h daily, 25% spend 3–5 h, and 11.3% spend 5–8 h on these platforms.

Figure 1.

Types of digital gadgets used by participants

Posture and ergonomics

The study found that 75.7% prefer reclining while using social media, and 75% adopt a similar posture for binge-watching, compared to 33.7% and 30% who sit upright, respectively. About 56% use smartphones one-handed, straining muscles, while 76.7% tilt their heads downward [Figure 2], and 72.3% bend their backs while using computers. 48% maintain a forward head position during gaming.

Figure 2.

Prevalence of forward head posture among participants

While 86.7% take breaks during social media use, 13.3% do not [Figure 3]. 53.7% use laptops in bed, and among those using a table and chair, 76.3% prefer full support, while 12.7% use only table support. 89% take breaks on computers, while 11% do not. Regarding mobile gaming, 28.7% play lying down, 24% sit, and 46% find it inapplicable.

Figure 3.

Frequency of breaks during digital gadget use

Musculoskeletal health

The study found that prolonged mobile phone use (social media, gaming) led to eyestrain (58%), neck pain (54.3%), backache (34%), headache (30.7%), shoulder pain (21.3%), wrist pain (20%), and arm pain (20%). Pain severity ratings varied, with 20.7% rating it as 3, 17% as 1, and 16.7% as 4. For computer users, common issues included backache (25.3%), neck pain (22.3%), headache (20.7%), and minor wrist (2.3%) and arm pain (3%). Among PlayStation users, 9.7% reported backache, 8.7% neck pain, and 9% eyestrain, though 74% did not use PlayStation. Pain severity was mostly mild, with 21.3% rating it as 3, 20.7% as 1, and 0.7% reporting severe pain (10/10). In the study, 27% of participants reported noticing clicking sounds lately when opening or closing their mouths, while the majority (73%) did not observe this phenomenon [Figure 4]. Additionally, 32% of participants reported experiencing muscle soreness in their cheeks or neck after using digital devices, whereas 68% did not report such discomfort [Figure 5].

Figure 4.

Prevalence of temporomandibular joint disorders in participants

Figure 5.

Prevalence of myofascial pain among participants

As shown in Table 2, neck pain was the most commonly noted symptom in the study participants, with an alarming 47.0%. This was followed by hand and wrist pain in 23.0% of the population.

Table 2.

Distribution of pain types among study respondents

Pain type	n (%)
Neck pain	141 (47.0)
Shoulder pain	37 (12.3)
Back pain	44 (14.6)
Hand and wrist pain	69 (23.0)
Thumb pain	29 (9.6)
Headaches	55 (18.3)
Eye strain	38 (12.6)
Sleep disturbances	34 (11.3)

n=number of cases

Awareness and education

The research indicated that 52.7% of participants feel somewhat informed about MSK risks associated with digital gadget use, whereas 32.7% consider themselves very informed, and 14.7% do not feel informed at all. Awareness of posture varied among respondents, with 42% occasionally conscious, 36.3% consistently aware, and 21.7% unaware.

Additionally, 77.3% have no MSK diagnosis, 14.3% are unsure, and 8.3% have received a diagnosis. Regarding ergonomic practices, 54.3% do not use accessories, 25.7% are unfamiliar with them, and 20% use them. 71% have not received ergonomic education, while 29% have. 58.7% do not exercise regularly, whereas 41.3% do.

Psychosocial factors

The study identified varying bedtime habits among participants, with 36% sleeping between 11 PM and 12 AM, 31% between 12 AM and 1 AM, and 24.3% between 10 PM and 11 PM, indicating a trend toward later bedtimes. Participants also reported varied sleep durations: 40.7% sleep 6–7 h, 18% sleep 7 h, 17% sleep 6 h, 14.3% sleep <6 h, 7.3% sleep more than 8 h, and 2.7% sleep only 3–4 h.

Regarding medical treatments, 80.7% reported not undergoing any, while among those receiving treatment, 3.3% are being treated for diabetes mellitus, 3% for hypothyroidism, 1.7% for hypertension, 0.3% for hyperthyroidism, 0.7% for cardiac issues, 0.7% for antidepressants, and 9.7% for other conditions.

When asked about stress or anxiety while using digital gadgets, 64% responded “No,” whereas 36% reported experiencing stress or anxiety. In contrast, when not using digital gadgets, 66.7% reported no stress, while 33.3% experienced stress or anxiety, suggesting that while most participants remain unaffected, a notable minority are impacted.

Recommendations and future trends

When asked about adopting new technologies to reduce MSK strain, 62.7% said “Yes,” 22% “Maybe,” 9% “No,” and 6.3% “I don’t know.”

Discussion

This discussion explores the various MSK issues associated with gadget usage and their implications for health and well-being. One of the primary factors contributing to MSK problems is prolonged screen time. Many people spend hours daily bent over their devices, often unaware of the effects on their posture. Poor ergonomic practices, such as slouching, craning the neck forward, or sitting in non-supportive chairs, can lead to conditions like FHP, rounded shoulders, and lower back pain. These postural deviations place undue stress on the MSK system, resulting in muscle strain and discomfort. MSK problems related to gadget usage affect individuals across all age groups. However, children and adolescents are especially susceptible due to the ongoing development of their MSK systems. Poor posture habits formed during these formative years can lead to long-term issues. Adults, especially those in sedentary jobs, also face significant risks, as they may spend large portions of their day seated in front of computers. The elderly, who might use these devices for social interaction and entertainment, are not exempt and may experience exacerbated MSK pain due to pre-existing conditions.

Demographics

In our study, definite gender prevalence was observed, with males (67.7%) being more than females (32.3%). Current studies in the literature suggest that females are generally more addicted to phones than males. However, this finding is not universally supported, as other studies have found no significant correlation between addiction and gender.[10]

Gadget ownership

In this study, 99.3% use mobile phones and 49.3% use laptops regularly. Similar findings were reported by Susilowati et al. (2022), where nearly all the community (>95%) used smartphones in the performance of daily activities.[11] Mobile phones, in particular, are associated with increased MSK strain due to their small screens and keyboards, which encourage awkward postures and muscle strain. Similarly, laptops, when used without proper ergonomic setups (e.g., separate keyboards and stands), can lead to prolonged periods of poor posture, contributing to neck, shoulder, and back pain.

Posture

In this study, 76.7% frequently tilt their heads downward while using phones, followed by 72.3% often bending their backs while using computers or laptops. A study conducted in 2022 by Susilowati et al.[11] reported similar findings. In a neutral position, an adult’s head weighs approximately 10–12 pounds. Every inch the head moves forward adds an extra 10–12 pounds of weight on the neck,[11] potentially causing muscle imbalances, increased muscle tension, altered joint mechanics, compromised blood flow, strain on fascial networks, nerve compression, and referred pain leading to myofascial pain dysfunction syndrome.

Prevalence of musculoskeletal disorders

In this study, the most common areas for MSK pain were the neck, followed by back pain, headache, and shoulder pain. According to the Global Burden of Disease 2010 study, the global point prevalence of neck pain was estimated at 4.9% (95% confidence interval: 4.6–5.3). Neck pain ranked as the fourth leading cause of disability, measured by years lived with disability, and 21^st in overall disease burden.[12] A study done in 2022 by Susilowati et al. found that 86.4% experienced neck pain, followed by lower back pain, 75.9%.[11] Similarly, a study conducted in 2022 by Gosain et al. found that neck pain was the most common MSK pain in computer users working from home during coronavirus disease (COVID-19).[6] Similar results were found in a study conducted by Tholl et al. among video gamers in 2022.[4] A study conducted by Alkhateeb et al. in 2020 found that 27.2% of participants admitted to using their mobile phones for more than 8 h per day, while 75% spent at least 4 h daily on their phones. This growing trend has been associated with various health and social issues, including non-traumatic MSK pain. Smartphone addiction is positively correlated with repetitive joint overuse, which can result in inflammatory changes in otherwise healthy joints.[10] The growing speed and accessibility of the internet significantly contribute to the increasing duration and frequency of gadget usage.[11] In this study, about 8.3% of participants were diagnosed with MSDs. Worldwide, the prevalence of MSK conditions has increased by 25% over the last decade, making up 2% of the total global disease burden.[5]

Additional findings: Jaw clicking and muscle soreness

In our study, 27% of participants noticed clicking sounds, and 32% experienced muscle soreness. A study by Ohmure et al. in 2008 indicated that when the condyle is positioned posteriorly, an additional force may be exerted on the posterior region of the temporomandibular joint (TMJ) during mastication and/or parafunction. Furthermore, posterior displacement of the condyle has been reported as a potential cause of TMDs, including TMJ disc displacement.[13]

Breaks and physical activity

Our bodies are naturally designed for motion rather than prolonged inactivity. Prolonged positions increase muscular load and joint compression, contributing to MSK symptoms.[7] Short, frequent pauses from computer use combined with exercise can minimize strain on the spine, neck, upper limbs, and eyes.[6] Repeated and sustained movements, such as those involved in mobile phone use, can lead to upper extremity pathologies.[14] Physical activity and exercise can counteract or prevent MSDs and are effective in their rehabilitation, reducing the negative impacts of prolonged gadget use.[4] However, excessive screen-based activities, both work-related and leisure, can significantly increase the risk of developing MSDs at any age.[4]

Awareness of musculoskeletal risks and consciousness of posture

Work-related MSDs are among the most common occupational disorders globally, recognized since the 17^th century (Ramazzini, 1964).[12] Insufficient knowledge of ergonomic practices and underreporting of problems contribute to the issue.[5] Factors such as physical activity, sleeping habits, psychosocial balance, socioeconomic status, and environmental and ergonomic conditions can impact the MSK system both positively and negatively.[4] Addressing static postures, particularly with a bowed neck and hunched shoulders, is crucial, as prolonged durations can lead to discomfort. It is advisable to change positions upon feeling distress.[11] Tholl et al. highlighted the link between stressful, uninterrupted work postures and neck pain.[4]

Ergonomic education

Numerous studies have identified a correlation between ergonomic factors and MSK symptoms (Bernard, 1994; Bonfiglioli, 2006; Ortiz-Hernandez, 2003; Szeto, 2009; Werner, 2005).[12] Effective ergonomic education is crucial for preventing and managing FHP by addressing its root causes and promoting healthier postural habits. Shariat et al. observed a reduction in neck pain following an ergonomic intervention, while the control group continued to experience persistent pain. Conversely, Côté et al. noted that while workstation adjustments improved neck symptoms, additional treatments, such as enhancing physical fitness, were necessary. Therefore, combining ergonomic interventions with improvements in workers’ physical capacity could yield better results.[15]

Bedtime habits and sleep durations

Inadequate sleep worsens clinical outcomes in individuals with MSK pain, increasing pain severity, psychological distress, and functional limitations. Numerous studies have linked sleep and MSK pain, finding poor psychological states more common in chronic MSK pain patients and highlighting the role of psychological factors in MSK pain development. Li et al. reported that poor sleep quality is associated with a higher number of painful joints, and 27% of chronic neck pain patients also experience pain in the low back, lower limbs, and joints. There is a bi-directional link between pain and sleep, with sleep disturbances often seen as secondary to chronic pain. However, new findings indicate that insomnia independently affects chronic pain development and prognosis.[16]

Stress and anxiety

Chronic MSK pain and reduced physical functionality are linked to a higher risk of mental health issues, such as fatigue, sleep problems, depression, and anxiety.[17] Studies have shown that MSK pain (MSP) and perceived stress increase muscle tension, particularly in the neck and shoulders, elevating the risk of MSDs.[18] Symptoms of anxiety, depression, fatigue, and insomnia worsen with the number and intensity of pain sites.[17]

Epidemic

The prevalence of MSDs due to gadget usage and poor posture is rising, resembling an epidemic. There has been a significant increase in neck pain, back pain, and repetitive strain injuries from prolonged digital device use across age groups. Research published in Journal of Clinical Medicine in 2022 found that TMD is the second most frequently occurring MSD causing pain and disability. MSP is present in 2%–12% of the population, with 10% reporting severe symptoms.[19] Al-Dhafer et al. reported a rise in smartphone addiction among Saudi university students from 19.1% in 2016 to 60.3% in 2019.[1] Zirek et al. found myofascial pain syndrome to be the most common condition related to mobile phone use, affecting 69% to 70.37% of cases. As mobile phones have become a necessity, related pathologies and MSK complaints are expected to increase.[14]

Primary care physicians’ role in temporomandibular disorders

TMDs affect 5–10% of the population, causing jaw, TMJ, and facial pain, often associated with fibromyalgia, migraines, and neck pain.[20] As the first point of contact, PCPs play a key role in early identification and management. Common features include myofascial pain, arthralgia, and disc displacement. PCPs can assess TMD through routine evaluations by identifying jaw pain, muscle tenderness, and joint dysfunction. Management includes self-care strategies such as heat/cold therapy, joint mobilization[20] and the 6S rule, soft diet, slow chewing, small bites, better sleep, and proper posture. Additional preventive measures include limiting screen time, stretching, and following the 20-20-20 rule to reduce strain.[11]

Study limitations

This study has some limitations. First, the self-reported nature of the questionnaire may introduce recall bias. Second, the study population primarily consisted of digitally active individuals, which may not fully represent those with minimal gadget use. Third, the cross-sectional design limits the ability to establish causation between digital device usage and MSDs. Longitudinal studies are needed to assess long-term effects more accurately.

Conclusion

The rise in MSDs due to digital device use calls for preventive measures. Key strategies include frequent breaks, regular exercise, proper sleep, and stress management. These steps help reduce chronic pain and support long-term MSK health.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.