Cervical flexion posture during smartphone use was not a risk factor for neck pain, but low sleep quality and insufficient levels of physical activity were. A longitudinal investigation.

Background: There is a lack of longitudinal studies investigating the association between cervical flexion posture during smartphone use (commonly referred to as text neck [TN]) and neck pain (NP).

Objective: To investigate whether TN is a risk factor for NP, considering the influence of lifestyle and psychosocial factors.

Methods: A 12-month longitudinal study. The sample consisted of 457 volunteers of both sexes, aged between 18 and 65 years, without NP. Sociodemographic, anthropometric, lifestyle, psychosocial, and smartphone-use data were collected through a self-reported questionnaire. TN was assessed objectively at baseline by measuring the cervical flexion angle using the cervical range of motion device (CROM) with participants standing and sitting while texting on their smartphones. One year after the initial assessment, participants were assessed regarding the point prevalence and frequency of NP.

Results: Of the total, 396 (87 %) participants completed the one-year follow-up. NP was reported by 40 (10 %) participants. Multiple logistic regression analysis showed that TN did not increase the chance of NP (standing OR [95 % confidence interval] = 1.0 [0.97, 1.04]; sitting OR = 1.01 [0.98, 1.04]) or frequency of NP (standing OR = 1.01 [0.99, 1.03]; sitting OR = 1.00 [0.99, 1.02]) after baseline. However, low sleep quality (OR = 1.76 [1.17, 2.63]) and insufficient level of physical activity (OR = 2.41 [1.03, 5.65]) increased the chance of NP.

Conclusion: Cervical flexion posture during smartphone use was not a risk factor for NP or frequency of NP, but low sleep quality and insufficient levels of physical activity were.