Written by
Christina Anderson, OT/L
VHSF Fellow ‘23/’24
It’s hard to imagine life before smartphones. How did we all manage to communicate, order essentials or schedule appointments? When was the last time we all went a few hours without picking up our devices? Yet smartphones are a relatively new piece of technology, having only become widely used in the late 2000’s to early 2010’s. They have provided a new era of convenience to people worldwide - many of whom are concurrently wondering why they’ve developed a problematic ache in their thumbs, or why that pain in their neck is now a daily annoyance. The Statista Research Service estimates that the non-voice time spent on phones as of 2024 is 279 minutes per day, close to 5 full hours of having a phone in hand (Laricchia, 2023). It is therefore not surprising that this daily habit is associated with pain and dysfunction.
Smartphone use often involves the user engaging in a forward head posture, looking down at the device in hand. The user may alternatively try holding the phone up higher, by using a static contraction of several upper limb muscles. During these activities, individuals may be holding the same position for a considerable duration of time without moving. They may also be engaging in repetitive use of the hand, specifically the thumbs being used for various scrolling and typing movements.
The prevalence of musculoskeletal disorders of the hand, wrist, arm, and neck has been increasing worldwide due to the prolonged, forceful, and repetitive use of hand-held devices. Ongoing and repetitive motions with the thumb and fingers have been identified as risk factors which may lead to disorders of the thumb and myofascial pain syndrome in the hand (Mustafaoglu et al., 2021). Mustafoglu et al. determined that the daily time spent using a phone was correlated with pain of the upper back, neck, wrists and hands. It was also determined that owning a mobile device for
over nine years was greatly associated with musculoskeletal pain prevalence.
A 2020 systematic review showed that the prevalence of musculoskeletal complaints among smartphone users ranged from 8.2%-89.9%. The most frequent musculoskeletal symptom associated with smartphone use was pain. Myofascial pain syndrome, thoracic outlet syndrome, fibromyalgia, tendonitis/tendonosis, and De Quervain's tenosynovitis were the most commonly-associated pathologies (Zirek et al., 2020).
In a different cross-sectional study of university medical students, the association between smartphone addiction and thumb and wrist pain was analyzed. The researchers first designated participants into two groups; those who were considered smartphone addicts and non-addicts. Both of these groups completed the patient-rated wrist and hand evaluation (PRWHE) to determine pain. The Finkelstein test was also administered, which is used in the diagnosis of DeQuervain’s Syndrome. The researchers concluded that heavy smartphone users had mild pain and stiffness in the thumb and wrist, with higher PRWHE scores. A positive Finkelstein test was not associated with heavy smartphone use in this study (Baabdullah et al., 2020).
Mitigating Risk Factors Associated with Smartphone Use
Proper ergonomics and posture when using phones may create less strain on muscles and nerves. Tapanya et al. (2021) analyzed the effects of shoulder posture on neck and shoulder loading and associated discomfort during smartphone use. The study determined that shoulder flexion angles equal to or greater than 45 degrees was associated with higher anterior deltoid and lower trapezius loading. Conversely, shoulder flexion angles of 15 degrees had the greatest upper trapezius and cervical erector spinae loading, with the authors attributing this to users using excessive shoulder elevation to improve screen readability. The ideal position for the shoulder
was found to be 30 degrees of shoulder flexion, eliciting the lowest neck/shoulder pain scores and the best combination of muscle activation.
Building upon ergonomics and positioning, utilizing support for the upper extremity can reduce muscle fatigue and strain. Resting the arms on a table or pillows can be a useful option to reduce the demands placed on the shoulder and surrounding musculature. These positions also encourage a more upright posture.
The importance of movement breaks and position changes cannot be overstated. Phone use often involves static positions of the neck, shoulder, and elbow, with repetitive motions of the thumbs. Both of these actions are associated with pain and dysfunction; static positions reduce blood flow to the tissues, and repetitive movements can lead to muscle fatigue and tendon dysfunction. The mantra “Your best posture is your next posture” emphasizes the importance of regular movement and position changes on the health and function of our tissues.
Using alternating movement patterns for scrolling and typing can be helpful. Users can provide a rest break for the small muscles of the thumb by incorporating larger muscle groups; this can be done by utilizing the pointer finger for scrolling the screen with the assistance of the shoulder, redirecting the work to the larger muscles of the upper extremity. Phone users can also switch hands periodically. The goal is to share the activity demands among different muscles to avoid overworking one area, which can lead to pain and overloaded tendons.
Other interventions include the use of tech features that may be helpful to reduce arm strain. An example of this would be speech-to-text to reduce the number of repetitive muscle contractions. A user may also opt to partition time on devices to include larger screens like tablets and personal computers. Overall, smartphone users should incorporate a variety of strategies to mitigate risk factors for pain and dysfunction.
Reference List
Baabdullah, A., Bokhary, D., Kabli, Y., Saggaf, O., Daiwali, M., & Hamdi, A. (2020). The association between smartphone addiction and thumb/wrist pain: A cross-sectional study. Medicine 99(10):p e19124, March 2020. DOI: 10.1097/MD.0000000000019124
Mustafaoglu R., Yasaci, Z., Zirek, E., Griffiths, M.D., & Ozdincler, A.R. (2021). The relationship between smartphone addiction and musculoskeletal pain prevalence among young population: a cross-sectional study. Korean Journal of Pain, 34(1), 72-81.https://doi.org/10.3344%2Fkjp.2021.34.1.72
Laricchia, Federica. (2023, December 6). Time spent with nonvoice activities on mobile phones every day in the United States from 2019-2024.Statista.https://www.statista.com/statistics/1045353/mobile-device-daily-usa ge-time-in-the-us/
Tapanya,W., Neubert M.S., Puntumetakul R., & Boucaut R. (2021). The effects of shoulder posture on neck and shoulder musculoskeletal loading and discomfort during smartphone usage. International Journal of Industrial Ergonomics, 85, https://doi.org/10/1016/j.ergon.2021.103175
Zirek, E., Mustafaoglu, R., Yasaci, Z., & Griffiths, M. (2020). A systematic review of musculoskeletal complaints, symptoms, and pathologies related to mobile phone usage. Musculoskelet Sci Pract. Oct;49:102196.https://doi.org/10.1016/j.msksp.2020.102196