PURPOSE: The purpose of this study is to investigate the effects of smartphone usage duration on neck pain and sense of position as well as Deep Cervical Flexor (DCF) fatigue in young and middle aged patients with chronic mechanical neck pain.

BACKGROUND: Neck pain is one of most common causes of musculoskeletal disorders with a prevalence up to 86.8 %. It may interfere with the ability to perform normal activities of daily living (ADL). Patients with neck pain may present with reduced Rang of Motion (ROM) and diminished cervical position sense.

There are many risk factors that have been associated with neck pain including physiological factors such as age or pathomechanical factors such as increased physical demand on the spine. Smartphone use has been proposed as a risk factor for the development of neck pain in young adults due to sustaining a prolonged static posture or repeating particular neck movements for long period. The adverse effects of smartphone increases as the duration of the use increases. Aging is associated with increased cervical reposition error and reduced DCF muscle endurance, yet it is not clear how older adults will respond to prolonged use of smartphone.

HYPOTHESES: Increased duration of smartphone use will

1. increase neck pain in middle aged compared to young adult patients with chronic mechanical.
2. decrease cervical position sense in middle aged compared to young adult patients with chronic mechanical neck pain.
3. increase DCF fatigue in middle aged compared to young adult patients with chronic mechanical neck pain.

RESEARCH QUESTION: Would increased duration of smartphone usage accentuate neck pain, cervical reposition error and DCF fatigue in middle aged compared to young adults with chronic mechanical neck pain?

Patients with chronic mechanical neck pain will be instructed to use a standard smartphone for web browsing, either for 10 or 30 minutes, while seated on a standard chair at two separate sessions. Task duration will be tested by a random order generated by the Excel software.

The outcome measures for this study will be neck pain, DCF fatigue and neck reposition error. All measures will be assessed prior to and immediately after performing the required task in each session by a single trained assessor.

Neck pain will be assessed using the visual analogue scale (VAS), proprioception acuity will be quantified by measuring the repositioning error angle using Cervical Range of Motion instrument (CROM) and DCF endurance will be quantified using the neck stabilizer pressure biofeedback device.

Inclusion Criteria:

1. Adult female patients with an age ranging from 18 to 60 years old.
2. Referred with a diagnosis of chronic mechanical neck pain for more than 3 months.
3. Patients should have at least a one year experience in using touch-screen smartphone.
4. Have a neck impairment of more than 8% on the neck disability index (NDI).

Exclusion Criteria:

1. Any history of upper extremity injury or surgery within the past year
2. Visual problems, dizziness and vertigo
3. Any deformity in the upper extremities or spine
4. Previous history of spinal surgery.
5. Neurological or systemic disorders that interfere with balance and sensation
6. Low back pain or deformity.
7. Patients with any red flags such as malignancy, infection, inflammation, myelopathy.
8. If patient having any physical difficulties interfering with the use of smartphone while sitting and standing.

self-representation of gender identity

Patients will a confirmed diagnosis of chronic mechanical neck pain for over 3 months.

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