IMPACT OF STRUCTURED STRETCHING PROGRAM ON CERVICAL PAIN AND POSTURE AMONG SMARTPHONE USERS
DOI:
https://doi.org/10.71000/k9htat83Keywords:
Cell Phone; Disability Evaluation; Exercise Therapy; Neck Pain; Posture; Proprioceptive Neuromuscular Facilitation; Students.Abstract
Background: Smartphone use has become a routine part of academic and daily life, particularly among university students. Prolonged mobile phone use often encourages sustained neck flexion, poor posture, and repeated strain on cervical muscles, which may contribute to neck pain and functional limitation. Therapeutic stretching and proprioceptive neuromuscular facilitation are commonly used physiotherapy approaches for reducing muscle tightness and improving cervical mobility, but their comparative effectiveness among smartphone users requires further clinical attention.
Objective: To compare the effects of stretching exercises and proprioceptive neuromuscular facilitation techniques on pain intensity and neck disability among university students with neck pain associated with smartphone use.
Methods: This single-blinded comparative experimental study was conducted among university students from medical science departments at Government College University Faisalabad over six months. A total of 80 participants aged 18–30 years with neck pain and smartphone use of at least six hours per day were recruited through convenience sampling and randomly allocated into two equal groups. Group A received structured cervical stretching exercises, while Group B received proprioceptive neuromuscular facilitation techniques for eight weeks. Pain intensity was measured using the Numeric Pain Rating Scale, and neck-related disability was assessed through the Neck Disability Index at baseline and after intervention. Data were analyzed using SPSS, with within-group and between-group comparisons performed after normality testing.
Results: Among 80 participants, 28 were aged 18–20 years and 52 were aged 21–23 years. Each group included 6 males and 34 females. In Group A, mean pain decreased from 1.45 ± 0.60 to 0.78 ± 0.83, while mean disability decreased from 25.35 ± 10.14 to 13.60 ± 7.66. In Group B, mean pain decreased from 2.00 ± 0.91 to 0.60 ± 0.71, while mean disability decreased from 37.05 ± 15.02 to 12.75 ± 5.85. Between-group analysis showed significant post-treatment differences for NPRS and NDI scores, with p = 0.001.
Conclusion: Both interventions improved cervical pain and neck disability among smartphone-using university students, but proprioceptive neuromuscular facilitation produced greater improvement than stretching exercises. PNF may be considered a useful physiotherapy option for managing smartphone-associated neck pain and functional limitation.
Keywords: Cell Phone; Disability Evaluation; Exercise Therapy; Neck Pain; Posture; Proprioceptive Neuromuscular Facilitation; Students.
References
Kroemer K. Cumulative trauma disorders: their recognition and ergonomics measures to avoid them. Applied ergonomics. 1989;20(4):274–80.
Childress MA, Stuek SJ. Neck pain: initial evaluation and management. American Family Physician. 2020;102(3):150–6.
Shafique K, Tahir I, Azam A. Comparing the effects of proprioceptive neuromuscular facilitation and muscle energy technique in non-specific neck pain: a randomised clinical trial. International Journal of Therapy And Rehabilitation. 2025;32(12):1–13.
Balkisli BC, Aydin G, Azim D, Atici E. Muscle Biomechanical Properties, Pain, and Disability in Chronic Neck Pain: The Associations With Demographic Factors. Pain Management Nursing. 2026.
Antoniraj S, Hassan HC, Baleswamy K. Forward neck posture on cervical pain among university students: effect of smartphone addiction. International Journal of Medical Engineering and Informatics. 2026;18(2):198–205.
Abadiyan F, Hadadnezhad M, Khosrokiani Z, Letafatkar A, Akhshik H. Adding a smartphone app to global postural re-education to improve neck pain, posture, quality of life, and endurance in people with nonspecific neck pain: a randomized controlled trial. Trials. 2021;22(1):274.
Saliba VL, Johnson GS, Wardlaw C. Proprioceptive neuromuscular facilitation. Rational Manual Therapies Williams & Wilkins. 1993;243.
Pach D, Blödt S, Wang J, Keller T, Bergmann B, Rogge AA, et al. App-Based Relaxation Exercises for Patients With Chronic Neck Pain: Pragmatic Randomized Trial. JMIR Mhealth Uhealth. 2022;10(1):e31482.
Ayhualem S, Alamer A, Dabi SD, Bogale KG, Abebe AB, Chala MB. Burden of neck pain and associated factors among smart phone user students in University of Gondar, Ethiopia. PLoS One. 2021;16(9):e0256794.
Correia IMT, Ferreira AS, Gomes JFM, Reis FJJ, Nogueira LAC, Meziat-Filho N. Cervical flexion posture during smartphone use was not a risk factor for neck pain, but low sleep quality and insufficient levels of physical activity were. A longitudinal investigation. Braz J Phys Ther. 2025;29(6):101258.
Hauser RA, Matias D, Rawlings BR. Cervicovagopathy: ligamentous cervical instability and dysstructure as a potential etiology for vagus nerve dysfunction in the cause of human symptoms and diseases. Front Neurol. 2025;16:1572863.
Marques J, Borges L, Andias R, Silva AG. Characterisation and assessment of the most popular mobile apps designed for neck pain self-management: A systematic search in app stores. Musculoskeletal Care. 2022;20(1):192-9.
Timurtaş E, Hüzmeli İ, Demirbüken İ, Polat MG. Clinical outcomes of asynchronous telerehabilitation through a mobile app are equivalent to synchronous telerehabilitation in patients with fibromyalgia: a randomized control study. BMC Musculoskelet Disord. 2025;26(1):118.
Kim WD, Shin D. Comparison of Outcomes of Physical Therapy Exercises Combined with Either a Video-Based Smartphone Application System or a Written Exercise Program Handout in 34 Patients with Non-Specific Neck Pain. Med Sci Monit. 2024;30:e945349.
Yaşarer Ö, Yilmaz HG, Doğan H. Comparison of two different delivery methods of home-based exercise on neck pain. Somatosens Mot Res. 2024;41(4):205-12.
Armfield N, Elphinston R, Liimatainen J, Scotti Requena S, Eather CE, Edirippulige S, et al. Development and Use of Mobile Messaging for Individuals With Musculoskeletal Pain Conditions: Scoping Review. JMIR Mhealth Uhealth. 2024;12:e55625.
Marcuzzi A, Nordstoga AL, Bach K, Aasdahl L, Nilsen TIL, Bardal EM, et al. Effect of an Artificial Intelligence-Based Self-Management App on Musculoskeletal Health in Patients With Neck and/or Low Back Pain Referred to Specialist Care: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(6):e2320400.
Ali RR, Elsayed SNM, Kamel RM, Fahmy EM, Hamdy HA. Effect of integrated neuromuscular inhibition technique on subjects with neck pain and forward head posture: a randomized controlled trial. J Man Manip Ther. 2025;33(5):401-11.
Kaya M, Ucgun H, Denizoglu Kulli H. The effect of proprioceptive neuromuscular facilitation on individuals with text neck syndrome: A randomized controlled study. Medicine (Baltimore). 2024;103(30):e38716.
Anan T, Kajiki S, Oka H, Fujii T, Kawamata K, Mori K, et al. Effects of an Artificial Intelligence-Assisted Health Program on Workers With Neck/Shoulder Pain/Stiffness and Low Back Pain: Randomized Controlled Trial. JMIR Mhealth Uhealth. 2021;9(9):e27535.
Madeleine P, Szeto GPY, Heredia-Rizo AM. Effects of biofeedback and strength training interventions on neck-shoulder sensory-motor responses among visual display unit users. A narrative review. J Electromyogr Kinesiol. 2024;79:102936.
Yu LJ, Yan X, Kim TH. Effects of combined jaw and cervicoscapular exercises on mouth opening and muscle properties in cervical extension type. Sci Rep. 2025;15(1):19049.
Zhou T, Salman D, McGregor A. mHealth Apps for the Self-Management of Low Back Pain: Systematic Search in App Stores and Content Analysis. JMIR Mhealth Uhealth. 2024;12:e53262.
Piruta J, Kułak W. Physiotherapy in Text Neck Syndrome: A Scoping Review of Current Evidence and Future Directions. J Clin Med. 2025;14(4).
García-Pérez-de-Sevilla G, Franco AB, Trinidad A, Gasque-Celma P, Del-Blanco-Muñiz J. Stress, pain intensity, and work productivity in individuals with chronic pain: a cross-sectional observational study. BMC Public Health. 2025;25(1):3805.
Fandim JV, Almeida de Oliveira L, Yamato TP, Kamper SJ, Costa LO, Maher CG, et al. Telerehabilitation for neck pain. Cochrane Database Syst Rev. 2025;8(8):Cd014428.
Dareh-Deh HR, Hadadnezhad M, Letafatkar A, Peolsson A. Therapeutic routine with respiratory exercises improves posture, muscle activity, and respiratory pattern of patients with neck pain: a randomized controlled trial. Sci Rep. 2022;12(1):4149.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Virsha Riaz , Dr Narmeen Haseeb , Zunaira Mehdi , Dr Sana Hafeez , Kashaf Waseem , Dr. Muhammad Sadeem Khalid , Dr Rafia Imtiaz (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
