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Neck Pain and Smart Phones

Phones and Forward Head Posture: Effects on the Cervical Spine

Modern technology like smart phones has significantly increased people’s ability to communicate with one another. However, a down side of this communication boom is people experiencing pain in their cervical vertebrae due to excessive Forward Head Posture (FHP). FHP is caused by repetitive and cumulative trauma to the neck, and shoulders, and weakens cervical flexor muscle, the midthoracic rhomboid muscle, and the upper and lower trapezius (Kim & Koo, 2016). When a person looks down at their phone for a long period how is that person predisposing themselves to cervical spine pain?

Guan et al. (2015) used photogrammetry to compare head tilt angle, the angle between the line joining the tragus and the canthus, neck tilt angle the angle between the line joining the seventh cervical vertebra to the tragus of the ear, forward head shift, the horizontal distance from the tragus and the seventh cervical vertebra, and the gaze angle, the angle between the horizontal and a line running through the canthus and the mobile phone volunteers used for the study, between a volunteer using a phone and when the volunteer was not using a phone in a neutral position. In most cases subjects showed significant deviations in head tilt angle, neck tilt angle, and forward head shift. These postural differences exert several pounds of pressure on the cervical spine, which is correlated with head and neck pain (Guan et al., 2015).

Kim and Koo (2016) used EMG to measure muscular fatigue in the cervical erector spinae, the upper and lower trapezius while using a smartphone. After twenty minutes the muscles experience signs of fatigue and is even greater at thirty minutes. Keeping the head in an unvaried posture with continuous muscle contraction leads to weakness and fatigue which can develop in to chronic cervical spine pain, due to static pressure increases on the cervical vertebrae (Kim & Koo, 2016).

Improper FHP caused by smartphone use is a situation that will likely become more common as the technology becomes further integrated with society. To help prevent or alleviate cervical spine pain caused by smart phone use, Kim and Koo (2016) recommend limiting usage to less than ten minutes at a time, and suggest looking at the phone with neutral spine instead of leaning over. Kim, Yeun, and Kim (2016) recommend a neck stabilization program shortly before extended smartphone use. Exercises that increase muscular strength and endurance of the upper trapezius and cervical erector spinae include isometric contraction exercises without moving the neck before returning back to the starting position, neck bending exercises, neck stretching and greater pectoral muscle stretching exercises in the supine position, upper back muscle-enhancing exercises while lying face down, placing both thumbs underneath the chin while sitting, and leaning against the wall in a standing upright position with the chin pulled in. These exercises reduced fatigue among the cervical erector spinae and trapezius muscles during smartphone use and could possibly prevent pain (Kim et al., 2016).


Guan, X., Fan, G., Wu, X., Zeng, Y., Su, H., Gu, G., . . . He, S. (2015). Photographic measurement of head and cervical posture when viewing mobile phone: A pilot study. European Spine Journal, 24(12), 2892-2898.

Kim, H., Yeun, Y., & Kim, S. (2016). Preventive effects of stretching and stabilization exercises on muscle fatigue in mobile phone users. Journal of Physical Therapy Science, 28(9), 2529-2532.

Kim, S., & Koo, S. (2016). Effect of duration of smartphone use on muscle fatigue and pain caused by forward head posture in adults. Journal of Physical Therapy Science, 28(6), 1669-1672