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Comment & Response
March 19, 2020

Head and Neck Injuries Associated With Cell Phone Use

Author Affiliations
  • 1School of Medicine, Department of Anaesthesia and Intensive Care, The University of Jordan, Amman, Jordan
  • 2School of Engineering, Civil Engineering Department, The University of Jordan, Amman, Jordan
JAMA Otolaryngol Head Neck Surg. Published online March 19, 2020. doi:10.1001/jamaoto.2020.0139

To the Editor We read with great interest the article titled “Head and Neck Injuries Associated With Cell Phone Use” by Povolotskiy el al,1 in which they concluded that many cell phone–related injuries to the head and neck were associated with common daily activities, such as texting while walking, and that some injuries bear a risk of long-term complications. The fact that this retrospective cross-sectional study used data from a national database made it impossible to assess postural effect on neck pain, in addition to limiting the ability to assess long-term effect of neck pain among young adults.

Several studies demonstrated that prolonged neck flexion is linked to neck and upper extremities pain owing to static muscular load taking place with prolonged neck flexion, in addition to the lack of support to the arms and repetitive movement of the fingers, particularly when using 1 hand only. Moreover, the severity of neck pain was positively correlated with the number of sent text messages.2,3 According to Park et al,4 the weight sustained by the spine significantly increases when tilting the head forward at different angles. An adult head weighs approximately 5 to 6 kg in the neutral position. As the head flexes forward, the forces applied on the neck surge to 13 kg at 15 degrees, 20 kg at 30 degrees, 25 kg at 45 degrees, and 30 kg at 60 degrees.

On the other hand, texting during walking reduces walking velocity and laterally deviates the patients from walking in a straight path. That is believed to happen owing to the increased cognitive demand on the working memory due to cognitive distraction, whereas reading leads to the same effects, but to a lesser extent.5 Furthermore, the duration of mobile phone use was found to significantly correlate to neck pain severity, which in turn increases health care seeking and analgesics use for neck pain.3

The best position for mobile phone use is sitting with a straight neck and supported forearms, while holding mobile phone with both hands and using both thumbs. Mobile phone use should be limited to short durations.

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Article Information

Corresponding Author: Isam Bsisu, MD, School of Medicine, The University of Jordan, PO Box 13046, Amman 11942, Jordan (isam_bsisu@hotmail.com).

Published Online: March 19, 2020. doi:10.1001/jamaoto.2020.0139

Conflict of Interest Disclosures: None reported.

Povolotskiy  R, Gupta  N, Leverant  AB, Kandinov  A, Paskhover  B.  Head and neck injuries associated with cell phone use [published online December 5, 2019].  JAMA Otolaryngol Head Neck Surg. doi:10.1001/jamaoto.2019.3678PubMedGoogle Scholar
Gustafsson  E, Johnson  PW, Lindegård  A, Hagberg  M.  Technique, muscle activity and kinematic differences in young adults texting on mobile phones.  Ergonomics. 2011;54(5):477-487. doi:10.1080/00140139.2011.568634PubMedGoogle ScholarCrossref
Al-Hadidi  F, Bsisu  I, AlRyalat  SA,  et al.  Association between mobile phone use and neck pain in university students: a cross-sectional study using numeric rating scale for evaluation of neck pain.  PLoS One. 2019;14(5):e0217231. doi:10.1371/journal.pone.0217231PubMedGoogle Scholar
Park  J, Kim  J, Kim  J,  et al.  The effects of heavy smartphone use on the cervical angle, pain threshold of neck muscles and depression.  Adv Sci Tech Lett. 2015;91(3):12-17. doi:10.14257/astl.2015.91.03Google Scholar
Schabrun  SM, van den Hoorn  W, Moorcroft  A, Greenland  C, Hodges  PW.  Texting and walking: strategies for postural control and implications for safety.  PLoS One. 2014;9(1):e84312. doi:10.1371/journal.pone.0084312PubMedGoogle Scholar
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