Prevalence of Text Neck Posture and Its Association with Smartphone Addiction Among Physical Therapy Students: A Cross-Sectional Study

Abstract

Background: Excessive smartphone use among university students has become a growing public health concern, particularly due to its musculoskeletal implications. Prolonged forward head flexion while using handheld devices contributes to text neck posture (TNP), a repetitive strain injury involving excessive cervical flexion and associated pain. Concurrently, smartphone addiction—a behavioral dependency characterized by compulsive device use and withdrawal symptoms—has been recognized as a potential risk factor for postural dysfunction and neck disorders. Objective: To determine the prevalence of text neck posture and its association with smartphone addiction among Doctor of Physical Therapy (DPT) students in Karachi, Pakistan. Methods: This cross-sectional study included 385 DPT students aged 17–25 years from six institutions in Karachi, recruited through convenience sampling. Participants completed a self-perception diagram-based assessment of neck posture during smartphone use and the Smartphone Addiction Scale–Short Version (SAS-SV). Data were analyzed using SPSS version 30.1. Chi-square tests and correlation analyses were performed to assess associations between smartphone addiction scores and TNP, with significance set at p < 0.05. Results: The prevalence of TNP was 66.49%, and 86.5% of participants met the criteria for smartphone addiction. A significant positive correlation was observed between overall smartphone addiction level and TNP (r = 0.319, p < 0.001). Females exhibited a higher prevalence of TNP (67.8%) compared to males (60.3%), though this difference was not statistically significant (p = 0.256). The strongest associations were found between “Neglect of Other Activities” and “Withdrawal” domains of smartphone addiction and poor posture. Conclusion: The study demonstrated a significant association between excessive smartphone use and text neck posture among DPT students, supporting a dose–response pattern between addiction severity and postural deviation. Preventive strategies emphasizing ergonomic awareness, reduced screen time, and posture correction are recommended within physiotherapy education.