Sedentary Behaviour, Prolonged Smartphone Use, and Neck Pain Among University Students: A Systematic Review and Quantitative Evidence Synthesis

Abstract

Smartphones are extensively used by university students for academic, social and recreational purposes. Prolonged smartphone interaction frequently occurs in sedentary positions involving sustained cervical flexion, limited postural variation and repetitive upper-limb activity. These behaviours have been proposed as contributors to neck pain, although the strength and consistency of the association remain uncertain. To systematically synthesize high-quality evidence published before 2021 concerning sedentary behaviour, prolonged smartphone exposure, cervical posture and neck pain among university students and young adults. A structured systematic review was conducted using evidence published no later than 31 December 2020. References were restricted to peer-reviewed Q1 journals within ergonomics, occupational health, spine, musculoskeletal medicine and multidisciplinary science. University-student studies were prioritized, while young-adult and occupational evidence was included when directly relevant to the biomechanical or behavioural mechanisms under investigation. Because exposure definitions and outcome measures were highly heterogeneous, statistical pooling was not considered methodologically appropriate. Neck pain was common among university students, although prevalence varied substantially according to case definition and population. A large 2020 undergraduate study reported a current neck-pain prevalence of 22.3%. Prolonged smartphone use showed only a modest association with neck pain in that study (OR 1.05, 95% CI 0.99–1.12). A five-year cohort of young adults found cross-sectional associations between texting and neck/upper-extremity symptoms, but prospective evidence for new-onset neck pain was substantially weaker. Experimental and field studies consistently demonstrated greater cervical flexion, altered cervical kinematics and reduced postural variation during smartphone tasks. However, forward-head or “text-neck” posture was not consistently associated with pain. Psychological stress, previous pain, task characteristics and physical activity appeared to modify risk. Prolonged smartphone use should be considered a contextual contributor to neck symptoms rather than an independently established cause. The most plausible risk pattern combines extended sedentary exposure, sustained or asymmetric cervical posture, limited movement variability and individual susceptibility. Prevention should emphasize postural variation, regular movement, task interruption and appropriate smartphone positioning rather than rigid posture correction alone.