Effects of Exercise Training Delivered Through Telerehabilitation on Text Neck Syndrome

Effects of Telerehabilitation Versus Supervised Physiotherapy on Neck Muscle Endurance, Pain, and Disability in KARABUK University Students With Text Neck Syndrome: A Randomized Controlled Trial

To compare the effectiveness of telerehabilitation exercise program with that of supervised in-person physiotherapy in improving neck muscle endurance, pain intensity, and functional disability in university students with text neck syndrome. Methods:

A randomized controlled trial was conducted with 31 university students aged 18-24 diagnosed with text neck syndrome. Participants were randomly assigned to either a telerehabilitation group or a supervised in-person exercise group. Both groups received an identical six-week exercise program, delivered three times per week, including stretching, range of motion, isometric, and postural correction exercises with progressive intensity. Primary outcomes included deep cervical flexor and extensor muscle endurance. Secondary outcomes were neck pain intensity and functional disability. Assessments were performed at baseline and post-intervention.

Introduction

Text Neck Syndrome, also known as turtle neck posture, is a repetitive stress injury of the neck associated with prolonged use of handheld electronic devices that disrupts cervical spine alignment and function. When users maintain a forward head posture, particularly while using smartphones, this can lead to upper back discomfort, muscle spasms, shoulder stiffness, and cramps due to increased mechanical load on cervical tissues. The term Text Neck was introduced to describe this phenomenon. Biomechanical modeling has shown that as cervical flexion increases, the mechanical load on the cervical spine rises substantially, which can encourage loss of the natural cervical curvature and promote kyphotic changes in the upper thoracic spine. These postural alterations may destabilize ergonomics and contribute to musculoskeletal dysfunction. If left untreated, text neck posture may result in long-term structural changes, including vertebral misalignment, neuromuscular impairment, and chronic pain syndromes. Additionally, abnormal head posture is associated with impaired proprioception, increased postural sway, and reduced balance control. Telerehabilitation, defined as the delivery of therapeutic interventions through digital platforms, offers a promising alternative to in-person therapy by overcoming barriers related to distance, mobility, and cost. Its widespread adoption during the COVID-19 pandemic demonstrated that remotely supervised neck exercise programs can produce results comparable to traditional care for chronic neck pain. Telerehabilitation has been associated with reduced pain intensity, improved physical function, and enhanced quality of life in individuals experiencing neck pain.

Eligibility Criteria

Inclusion Criteria:

Participants will be eligible for inclusion if they meet all of the following criteria:

Are between 18 and 24 years of age.

Report smartphone use exceeding 3 hours per day.

Present with at least three of the following symptoms:

Neck pain

Shoulder pain

Upper back pain

Headache

Insomnia

Tingling or numbness in the hands

All participants will be screened for eligibility by a licensed physiotherapist, and only those who meet all inclusion and none of the exclusion criteria will be randomized.

Exclusion Criteria:

Participants will be excluded if they meet any of the following criteria:

Have a known orthopedic or neurological condition.

Have a history of recent cervical or spinal surgery.

Have a diagnosed psychiatric disorder.

Have any medical contraindication to performing physical activity or exercise.