Smartphone Use and Musculoskeletal Disorders: A Systematic Review of Epidemiological Evidence and Potential on Inflammatory Mechanisms
Abstract
Smartphone use among adults has increased and often involves prolonged exposure with sustained non-neutral neck posture. Epidemiological studies report a high prevalence of neck and shoulder pain among frequent users. Biomechanical loading of the cervical spine is considered a main mechanism, while inflammatory processes have been proposed as an additional pathway. This systematic review evaluated the association between smartphone use and musculoskeletal complaints, focusing on inflammatory biomarkers as a potential biological mechanism.
The review followed PRISMA 2020 guidelines. Searches were conducted in PubMed and ScienceDirect for peer-reviewed studies published between 2018 and 2025. Eligible studies included adults aged 18 years or older who reported smartphone use exceeding 2 to 3 hours per day. Exposure was commonly assessed using self-report questionnaires or structured surveys. Studies examining neck or shoulder outcomes, posture, or inflammatory biomarkers were included. Observational studies, randomized controlled trials, and ergonomic interventions were eligible.
Thirty studies met the inclusion criteria. Most reported significant associations between prolonged smartphone use, sustained neck flexion, and musculoskeletal pain in the neck and shoulders. Prevalence ranged from moderate to high among students and workers with a daily use of 3 to 9 hours. No included study directly measured inflammatory biomarkers in general smartphone users. Related evidence indicates elevated IL-6 and C-reactive protein in sedentary populations with high device exposure.
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References
Ahmed, S., Mishra, A., Akter, R., Shah, M. H., & Sadia, A. A. (2022). Smartphone addiction and its impact on musculoskeletal pain in neck, shoulder, elbow, and hand among college going students: a cross-sectional study. Bulletin of Faculty of Physical Therapy, 27(1), 5. https://doi.org/10.1186/s43161-021-00067-3
Akodu, A. K., Akinbo, S. R., & Young, Q. O. (2018). Correlation among smartphone addiction, craniovertebral angle, scapular dyskinesis, and selected anthropometric variables in physiotherapy undergraduates. Journal of Taibah University Medical Sciences, 13(6), 528–534. https://doi.org/https://doi.org/10.1016/j.jtumed.2018.09.001
Al-Hadidi, F., Bsisu, I., AlRyalat, S. A., Al-Zu’bi, B., Bsisu, R., Hamdan, M., Kanaan, T., Yasin, M., & Samarah, O. (2019). Association between mobile phone use and neck pain in university students: A cross-sectional study using numeric rating scale for evaluation of neck pain. PloS One, 14(5), e0217231. https://doi.org/10.1371/journal.pone.0217231
Alghadir, A. H., Gabr, S. A., Rizk, A. A., Alghadir, T., Alghadir, F., & Iqbal, A. (2025). Smartphone addiction and musculoskeletal associated disorders in university students: biomechanical measures and questionnaire survey analysis. European Journal of Medical Research, 30(1), 274. https://doi.org/10.1186/s40001-025-02413-w
Anan, T., Kajiki, S., Oka, H., Fujii, T., Kawamata, K., Mori, K., & Matsudaira, K. (2021). Effects of an Artificial Intelligence–Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial. JMIR MHealth and UHealth, 9(9). https://doi.org/https://doi.org/10.2196/27535
Ayhualem, S., Alamer, A., Dabi, S. D., Bogale, K. G., Abebe, A. B., & Chala, M. B. (2021). Burden of neck pain and associated factors among smart phone user students in University of Gondar, Ethiopia. PLoS ONE, 16(9 September), 1–15. https://doi.org/10.1371/journal.pone.0256794
AzizAli, N., & Sreedharan, J. (2024). Ergonomic awareness and practices to prevent musculoskeletal disorder among healthcare workers in UAE: A cross-sectional study. Journal of Bodywork and Movement Therapies, 40, 1973–1978. https://doi.org/https://doi.org/10.1016/j.jbmt.2024.10.022
Baek, S., Kim, G., & Park, H.-W. (2020). A mobile delivered self-exercise program for female farmers. Medicine, 99(52), e23624. https://doi.org/10.1097/MD.0000000000023624
Banadaki, F. D., Rahimian, B., Moraveji, F., & Varmazyar, S. (2024). The impact of smartphone use duration and posture on the prevalence of hand pain among college students. BMC Musculoskeletal Disorders, 25(1), 574. https://doi.org/10.1186/s12891-024-07685-7
Bertozzi, L., Negrini, S., Agosto, D., Costi, S., Guccione, A. A., Lucarelli, P., Villafañe, J. H., & Pillastrini, P. (2021). Posture and time spent using a smartphone are not correlated with neck pain and disability in young adults: A cross-sectional study. Journal of Bodywork and Movement Therapies, 26, 220–226. https://doi.org/https://doi.org/10.1016/j.jbmt.2020.09.006
de Souza, J. M., Tebar, W. R., Delfino, L. D., Tebar, F. S. G., Gobbo, L. A., Franco, M., da Silva, C. C. M., Oliveira, C. B. S., & Christofaro, D. G. D. (2023). Association of Musculoskeletal Pain With Sedentary Behavior in Public School Teachers: The Role of Habitual Physical Activity. Pain Management Nursing, 24(2), 196–200. https://doi.org/https://doi.org/10.1016/j.pmn.2022.08.005
Depreli, O., & Angin, E. (2024). The relationship between smartphone usage position, pain, smartphone addiction, and hand function. Journal of Back and Musculoskeletal Rehabilitation, 37(6), 1695–1704. https://doi.org/10.3233/BMR-240154
Farooq, M., Bashir, M. S., Arif, A., Kashif, M., Manzoor, N., & Abid, F. (2023). Effects of elongation longitudinaux avec decoaption osteo-articulaire and post-facilitation stretching technique on pain and functional disability in mobile users with text neck syndrome during COVID-19 pandemic: A randomized controlled trial. Medicine, 102(12), e33073. https://doi.org/10.1097/MD.0000000000033073
Intipanya, N., Sihawong, R., & Janwantanakul, P. (2025). Effects of a smartphone game to facilitate active neck movements on the incidence of neck pain among office workers: A 6-month cluster-randomized controlled trial. Musculoskeletal Science and Practice, 75, 103243. https://doi.org/https://doi.org/10.1016/j.msksp.2024.103243
Kamel, D. M., Hakeem, C. Al, & Tantawy, S. A. (2020). Influence of hand and smartphone anthropometric measurements on hand pain and discomfort: A cross-sectional study. Medicine, 99(11), e19513. https://doi.org/10.1097/MD.0000000000019513
Khan, M. R., & Ambati, T. (2022). Musculoskeletal pain symptoms in users performing smartphone texting: A preliminary study on institute environment. International Journal of Industrial Ergonomics, 90, 103325. https://doi.org/10.1016/j.ergon.2022.103325
Kurtaran, M. (2024). Comparison of musculoskeletal pain and upper extremity disability in smartphone addicts and smartphone non-addicts among university students: A cross-sectional study. Journal of Bodywork and Movement Therapies, 40, 279–285. https://doi.org/https://doi.org/10.1016/j.jbmt.2024.04.041
Labeeb, A., Serag, D. M., Latif, A. A. R. A., & Fotoh, D. S. (2021). Clinical, electrophysiological, and ultrasound evaluation for early detection of musculoskeletal hand disorders and nerve entrapment in mobile phone users. Revista Colombiana de Reumatología, 28(4), 267–275. https://doi.org/https://doi.org/10.1016/j.rcreue.2020.08.004
Ladeira, B. M., Modena, A. L., Castro Carletti, E. M. de, Bigaton, D. R., Pelai, E. B., & Mescollotto, F. F. (2023). Pain, smartphone overuse and stress in physiotherapy university students: An observational cross-sectional study. Journal of Bodywork and Movement Therapies, 34, 104–109. https://doi.org/https://doi.org/10.1016/j.jbmt.2023.04.018
Li, R., Li, T., Xie, Y., Zhai, S., Qu, Y., Zhang, D., Zou, L., Yang, Y., Wu, X., Tao, F., & Tao, S. (2023). Smartphone Use and Inflammation at 2-Year Follow-Up in College Students: The Mediating Role of Physical Activity. Psychology Research and Behavior Management, Volume 16, 1509–1519. https://doi.org/10.2147/PRBM.S411043
Ma’touq, J., Alnuman, N., Abuzer, I., & AbdelGader, B. (2023). The association between mobile phone use and neuromusculoskeletal complaints. Work, 76(2), 759–769. https://doi.org/10.3233/WOR-220650
Metin, G., Topuz, S., & Yagci, G. (2023). Smartphone use affects gait performance, spinal kinematics and causes spinal musculoskeletal discomfort in young adults. Musculoskeletal Science and Practice, 66, 102819. https://doi.org/https://doi.org/10.1016/j.msksp.2023.102819
Morcillo-Muñoz, Y., Sánchez-Guarnido, A. J., Calzón-Fernández, S., & Baena-Parejo, I. (2022). Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial. Journal of Medical Internet Research, 24(5), e36114. https://doi.org/10.2196/36114
Naeimi, E., Olyaei, G. R., Hadian, M. R., Talebian, S., & Khanmohammadi, R. (2024). Comparing repeated end range movements and Kinesio taping effects on head and neck movement pattern and discomfort in smartphone users. Journal of Bodywork and Movement Therapies, 40, 1949–1956. https://doi.org/https://doi.org/10.1016/j.jbmt.2024.10.044
Rafiyan, M., Azadchehr, M. J., Fazeli, A. M., & Jalalati, N. (2025). Examining the prevalence of neck and hand disorders and its relationship with smartphone addiction in medical students. BMC Musculoskeletal Disorders, 26(1), 621. https://doi.org/10.1186/s12891-025-08809-3
Rahimian, B., Banadaki, F. D., Moraveji, F., & Varmazyar, S. (2024). Examining the relationship between smartphone characteristics and the prevalence of hand discomfort among university students. BMC Public Health, 24(1), 2573. https://doi.org/10.1186/s12889-024-20051-5
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, 103175. https://doi.org/https://doi.org/10.1016/j.ergon.2021.103175
Tezcan, E. A., & Erbay, A. (2025). Ultrasonographic evaluation of neck extensor muscle thickness in smartphone users. Revista Da Associacao Medica Brasileira (1992), 71(6), e20242098. https://doi.org/10.1590/1806-9282.20242098
Thorburn, E., Pope, R., & Wang, S. (2021). Musculoskeletal symptoms among adult smartphone and tablet device users: a retrospective study. Archives of Physiotherapy, 11(1), 1. https://doi.org/10.1186/s40945-020-00096-6
Yoo, H.-I., Hwang, U.-J., Kim, J.-H., & Kwon, O.-Y. (2025). Identifying distinct scapular upward rotation patterns in individuals with upper trapezius–associated neck pain using unsupervised clustering approach. Musculoskeletal Science and Practice, 80, 103396. https://doi.org/https://doi.org/10.1016/j.msksp.2025.103396
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