Influence of Axial Load and a 45-Degree Flexion Head Position on Cervical Spinal Stiffness in Healthy Young Adults

Physiotherapy in Text Neck Syndrome: A Scoping Review of Current Evidence and Future Directions

Background: Musculoskeletal disorders associated with excessive smartphone use represent a significant health issue. Text neck syndrome is one such disorder within that group, increasingly affecting individuals worldwide across various age groups. The phenomenon of text neck may occur in individuals who frequently and for prolonged periods adopt a forward-flexed neck and head position while looking at the screens of mobile electronic devices. Various therapeutic methods are used in the treatment of text neck syndrome. However, there is no consensus on text neck rehabilitation, which poses a challenge for physiotherapists. Objective: The aim of this study is to analyze the phenomenon of text neck, with a particular emphasis on current scientific reports regarding the rehabilitation of text neck syndrome. The scoping review was conducted to determine the physiotherapy methods currently used in the treatment of individuals with text neck, assess their impact on symptom reduction, and identify existing knowledge gaps and limitations in the current literature on the rehabilitation of text neck syndrome. Design: A scoping review was conducted on the treatment of text neck syndrome based on electronic databases: PubMed, ResearchGate, Physiotherapy Evidence Database (PEDro), and the Cochrane Library. The databases were searched up to 1 December 2024. The inclusion criteria comprised studies investigating physiotherapy interventions for individuals with text neck, published between 2018 and 2024 and written in English. Results: A total of fifteen papers were reviewed, focusing on various methods used in text neck rehabilitation, including postural correction exercises, stabilization exercises, strengthening and stretching exercises, Pilates, PNF (Proprioceptive Neuromuscular Facilitation), kinesiology taping, Bowen therapy, and manual therapy. Nearly all studies were conducted in the adult population (93%), with the majority of studies taking place in India (60%). Conclusions: In summary, all studies suggest that appropriate physiotherapeutic interventions can provide significant benefits, including pain reduction, posture correction, and improved range of motion in the cervical spine. The best outcomes appear to be achieved by combining various therapeutic techniques. However, further high-quality research is needed to strengthen the evidence and offer reliable recommendations for clinical practice. Additionally, there is limited research on physiotherapy for text neck in the pediatric population, presenting a potential area for future studies.

50% body weight loading reduces stature increases and lumbar disc expansion from 4 h hyper-buoyancy floatation versus 15 min sitting upright

Microgravity is associated with stature increases, back pain and post-flight intervertebral disc (IVD) herniation. This study aims to determine whether 30 s seated 50% body weight (BW) axial loading is comparable to 15 min sitting upright in 1 g upon changes in stature, anterior lumbar IVD height (via ultrasound), passive vertebral stiffness (VS), and back pain induced by 4 h hyper-buoyancy floatation (HBF) unloading. Sixteen (seven male) healthy volunteers had stature, lumbar IVD height (L2-S1), passive VS (C1-L5) and back pain assessed before and following 4 h HBF, and immediately after participants performed a 30 s seated squat with 50% of their BW or 15 min sitting upright. Four hours of HBF unloading induced significant increments in stature (+1.6 ± 0.5 cm; P < 0.001), IVD height (L2-L3: P = 0.002; L3-L4: P < 0.001; L4-L5: P = 0.013; L5-S1: P < 0.001) and back pain (2.90 ± 1.26; P < 0.001) with no differences between 1 and 1.5 BW. Stature, IVD height increments and back pain were similarly attenuated in both reloading groups. Passive VS was unchanged by 4 h HBF or reloading. HBF-induced back pain positively correlated with stature (P = 0.01) and lumbar IVD height changes (L2-L3: P = 0.03; L3-L4: P = 0.01; L5-S1: P = 0.02). Four hours of HBF increased stature, lumbar IVD height and induced moderate back pain that were similarly (albeit not entirely) ameliorated by both 15 min upright sitting and 30 s of 50% BW axial loading, with no changes in passive VS observed. IVD geometric changes appear key to space adaptation back pain and stature increments that can be rapidly modulated by brief periods of axial loading.

Biomechanical analysis of cervical spine (C2-C7) at different flexed postures

Musculoskeletal diseases are often related with postural changes in the neck region that can be caused by prolonged cervical flexion. This is one of the contributing factors. When determining the prevalence, causes, and related risks of neck discomfort, having a solid understanding of the biomechanics of the cervical spine (C1-C7) is absolutely necessary. The objective of this study is to make predictions regarding the intervertebral disc (IVD) stress values across C2-C7 IVD, the ligament stress, and the variation at 0°, 15°, 30°, 45°, and 60° of cervical neck angle using finite element analysis (FEA). In order to evaluate the mechanical properties of the cervical spine (particularly, C2-C7), this investigation makes use of computed tomography (CT) scans to develop a three-dimensional FEA model of the cervical spine. A preload of 50 N compression force was applied at the apex of the C2 vertebra, and all degrees of freedom below the C7 level were constrained. The primary objective of this investigation is to assess the distribution of von Mises stress within the IVDs and ligaments spanning C2-C7 at various flexion angles: 0°, 15°, 30°, 45°, and 60°, utilizing FEA. The outcomes derived from this analysis were subsequently compared to previously published experimental and FEA data to validate the model's ability to replicate the physiological motion of the cervical spine across different flexion angles.

Ergonomic evaluation of upper extremities muscle activity pattern during 60-min smartphone texting

BACKGROUND

Smartphone usage has increased rapidly in the last decade due to rapid technological advancements. This extensive usage of smartphones led to physiological problems and musculoskeletal disorders (MSD) due to inappropriate postures.

OBJECTIVE

Past studies have reported the effects/discomfort of smartphone usage for short periods, ranging from 3-20 min, which does not represent the current era of smartphone dependency (approximately 7-hr/day).

METHODS

This study was performed on fifty-four participants aged 20-28 with 1-hr smartphone texting in a sitting posture. Flexion angles, both sides (dominant and non-dominant) muscle activity (maximum voluntary contraction %) at sternocleidomastoid (SCM), upper-trapezius (TRP), extensor digitorum (EDM) and abductor pollicis brevis (APB) muscles, and subjective discomfort were analyzed.

RESULTS

After 1-hr smartphone texting, the muscle activity at eight upper extremities: SCM (24.80%), TRP (29.45%), EDM (14.44%) and APB (19.87%) significantly (p < 0.001) increased by 1.5-1.9 times with 27.4±3.18° and 82.94±7.03° head and lower-arm flexion angles, respectively. The mechanical loads on the cervical spine increased by 4.6 times, and subjective discomfort by 3 times.

CONCLUSION

Maintaining the same posture for a long duration causes postural stress, muscular imbalances, and discomfort, leading to MSD with increased cervical intervertebral disc pressure.