Your screen time may not tell the whole story about neck health

By Dr. Liji Thomas, MDReviewed by Lauren HardakerOct 27 2026

A study of young women suggests that problematic smartphone use, not necessarily scrolling time, may be linked to changes in neck posture, reduced mobility, and greater neck-related disability, although the associations were weak.

Study: The association of smartphone use and addiction with neck pain, neck disability, physical activity, forward head posture, cervical range of motion, and neck muscle endurance in female college students. Image credit: beauty-box/Shutterstock.com

A recent study in BMC Musculoskeletal Disorders suggests that problematic smartphone use may be associated with neck posture and functional impairment in young women, though the weak associations and lack of statistically significant associations between most outcomes and total phone hours limit the strength of the conclusions.

Does problematic smartphone use affect posture and neck function?

Smartphones are widely used worldwide for many purposes. Their overuse and long-term use may become problematic or potentially addictive and may be associated with a range of adverse musculoskeletal outcomes. Previous research has linked prolonged forward head posture during smartphone use to increased neck loading, chronic neck pain, and changes in neck muscle strength and endurance.

However, little is known about whether this relationship holds true with subclinical or postural neck pain. The current study set out to test whether smartphone use and smartphone addiction scores are separately associated with neck pain, neck disability, physical activity, forward head posture, cervical range of motion (ROM), and neck muscle endurance in young women.

Researchers assess smartphone habits and neck function in young women

This was a cross-sectional, observational study of 63 female students aged 18–25 (mean 21.4 years) from the Faculty of Health Sciences at Necmettin Erbakan University. Only women were enrolled to get a homogeneous sample.

Women with reported neck pain at least twice in the preceding year, or with conditions that might cause cervical pain or movement restriction, were excluded. The researchers calculated a sample size of 60, assuming an effect size of 0.80, with three additional participants to allow for dropout.

The researchers collected data on phone use, daily smartphone time, screen time, and the reported percentages of phone use allocated to activities such as social media, messaging, calling, studying, and reading news.

They measured problematic smartphone use using the Smartphone Addiction Scale–Short Version (SAS-Sv, Turkish version), with ten items scored 1–6. Participants self-reported physical activity, cervical pain, and neck disability, while examiners measured musculoskeletal outcomes using a goniometer and timed endurance test.

They then analyzed these measures using Pearson correlations, with significance at p < 0.05 and no correction for multiple comparisons.

High smartphone use accompanied generally low neck disability scores

Participants used their phones about 6.1 hours a day, with an average of six hours of screen time. Social media and entertainment were the most commonly reported smartphone activities, with an average reported usage percentage of about 46%, followed by messaging (27%), studying (25%), and talking (22%). These reported percentages were not presented as mutually exclusive proportions of total phone use.

The mean addiction questionnaire score was 29.8 out of a maximum of 60. The neck functional disability score was 4.62 out of a maximum of 30, and the mean pain score was 3.6 out of 10.

Physical activity averaged about 2,505 metabolic-equivalent-minutes/week. The mean forward head posture angle was 31.7° while sitting, and 35° while standing. Mean flexor endurance was 21.5 seconds and extensor endurance 86.9 seconds. About 16% reported chronic neck pain, despite the eligibility criteria excluding women who had experienced neck pain at least twice in the preceding year.

Screen time shows few associations with neck health measures

The researchers found weak positive associations between smartphone usage (time in hours) and neck flexor endurance. They found a similar association for screen time. Unexpectedly, increased phone use and screen time were weakly associated with greater neck flexor muscle endurance.

Neither phone use nor screen time showed statistically significant associations with any other measured outcome.

Higher addiction scores linked to posture and neck disability

Higher smartphone addiction questionnaire scores were more strongly associated with outcomes than usage time, including forward head posture (sitting and standing), neck disability (the strongest association in this study), and reduced range of motion in neck flexion, right rotation, and left lateral flexion.

However, addiction scores were not significantly related to the intensity of neck pain, neck muscle endurance (flexor or extensor), or physical activity. The percentage of phone time spent on social media and entertainment showed a weak association with forward head posture (both sitting and standing), but with no other outcomes.

The authors rated all significant correlations as being weak.

Problematic smartphone habits may matter more than usage duration

The authors argued from this that smartphone addiction scores may be more closely associated with postural and functional outcomes than duration of use. They suggest that repeated non-neutral head and neck positions during smartphone use could contribute to postural adaptations and changes in neck biomechanics. They also proposed that problematic smartphone use may be associated with restrictions in specific neck movements rather than an overall reduction in cervical mobility.

The authors offered two possible explanations for the lack of any observable significant association with neck pain: the relative youthfulness of the participants and the possibility that addiction is related to changes in function and posture rather than a pain response.

Similarly, they note that the positive link between total duration of phone use and flexor endurance may reflect individual differences in muscle capacity, or a bidirectional relationship. Longitudinal studies are essential to distinguish such effects.

Smartphones are used during multiple activities, and therefore phone time may not reflect overall physical activity or sedentary behavior. This might account for the lack of association with physical activity.

Small female-only sample limits broader interpretation of findings

The findings should be interpreted with caution, given the study's relatively small sample of young women and its cross-sectional design, which cannot establish whether problematic smartphone use contributes to changes in neck posture or function. The results may also not apply to other age groups or men.

Reliance on self-reported smartphone use may have introduced inaccuracies, while the lack of adjustment for multiple statistical comparisons increases the possibility that some associations arose by chance. The researchers therefore consider the findings exploratory and call for larger, more diverse studies using objective measures of smartphone use and physical activity, alongside longitudinal and intervention research to clarify the relationships observed.

Problematic phone use may signal changes in neck function

This study suggests that smartphone addiction among female college students may be associated with neck posture and functional outcomes rather than simply with smartphone usage time or total screen time.

Further larger longitudinal and intervention studies are needed to clarify the mechanisms and test whether targeting smartphone addiction reduces neck musculoskeletal problems.