A Cross-Sectional Study on Smartphone Usage and Craniovertebral Angle: Key Predictors of Neck Pain in Adolescents

Abstract

Purpose: Smartphone use and craniovertebral angle (CVA) have been linked to neck pain in adolescents. However, the multifactorial contributors to neck pain remain unclear. Identifying its predictors is essential for informing preventive strategies. This study investigated smartphone use, craniovertebral angle, and other factors as predictors of neck pain in school-aged adolescents. Study Design: Cross-sectional study. Place and Duration of Study: Sample: six public high schools from the state education network in Pernambuco, Brazil, under the jurisdiction of the Education Department of Pernambuco. Methodology: Adolescents (14-19 years), were divided into neck pain (69, 62,7%)  and no pain (41, 37,3%). They completed a questionnaire on smartphone use and musculoskeletal symptoms. Pain was assessed using the Visual Analog Scale and the Neck Disability Index, while physical activity was evaluated with the IPAQ short version. CVA was analyzed using CorelDraw software. Binomial logistic regression was performed to identify predictors of neck pain, reporting odds ratios (OR) with 95% confidence intervals (CI). The model’s explanatory power was assessed using Nagelkerke’s R², which estimates the proportion of variance in neck pain explained by the predictors. Results: Excessive smartphone use (>4 hours/day) was a predictor of neck pain (OR = 5.06, p = 0.001), along with a smaller craniovertebral angle (OR = 0.90, p = 0.023) and upper limb musculoskeletal symptoms (OR = 3.18, p = 0.014). Tablet possession was associated with lower odds of neck pain (OR = 0.37, p = 0.046). The model explained 17.6% of the variance in neck pain ( R² = 0.176). Conclusion: Excessive smartphone use, a smaller craniovertebral angle, and upper limb musculoskeletal symptoms were predictors of neck pain in adolescents, highlighting the need for preventive strategies to reduce modifiable risk factors.