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 Table of Contents  
Year : 2020  |  Volume : 7  |  Issue : 5  |  Page : 65-68

Effect of cervical muscle strengthening and ocular muscle training among students with smartphone adversity

1 Dr. D. Y. Patil College of Physiotherapy, Pune, Maharashtra, India
2 Orthoptics, Ocular Motility and Binocular Vision, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India

Date of Web Publication26-Feb-2020

Correspondence Address:
Mayura P Deshmukh
Dr. D. Y. Patil College of Physiotherapy, Pimpri, Pune, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_73_19

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Background: Neck pain and visual disturbances are the major adversity observed among the smartphone users. Neck pain is frequently treated but visual impairments are often overlooked. Aim: The aim of the study was to evaluate the effect of cervical muscle strengthening and ocular muscle training among students with smartphone adversity. Materials and Methodology: Thirty smartphone users including both male and female having neck pain and visual impairment (smartphone adversity) were recruited for the study. Four types of cervical muscle strengthening exercise repeated five times and four types of ocular muscle training were performed by the students for 2 weeks once a day. Pre- and post outcome measures (ocular surface disease index [OSDI] and pressure biofeedback) were assessed. Results: The pressure biofeedback reading pre intervention was 23.3 ± 1.11 and postintervention was 28.1 ± 1.96. The pre-OSDI score was 20.3 ± 5.5 which reduced to 7.7 ± 3.07 post intervention. There was a statistically significant difference for both the outcome measures. Conclusion: Cervical muscle strengthening and ocular muscle training are effective for the students having smartphone adversity.

Keywords: Cervical muscle, ocular muscle training, pressure biofeedback, smartphone user

How to cite this article:
Deshmukh MP, Palekar TJ, Bajare U. Effect of cervical muscle strengthening and ocular muscle training among students with smartphone adversity. J Dent Res Rev 2020;7, Suppl S2:65-8

How to cite this URL:
Deshmukh MP, Palekar TJ, Bajare U. Effect of cervical muscle strengthening and ocular muscle training among students with smartphone adversity. J Dent Res Rev [serial online] 2020 [cited 2022 Dec 9];7, Suppl S2:65-8. Available from: https://www.jdrr.org/text.asp?2020/7/5/65/278909

Editor: Dr. Pradnya Kakodkar

  Introduction Top

Advanced mobile phones turned into a natural part of human's life as a result of its gigantic preferred position to mankind.[1] A smartphone incorporates advanced computer functionality, such as Internet communication, video recovery, and e-commerce making the device one of the needs of many people.[1],[2] Mobile phones are continually being improved by developing their functionalities, which thusly improve the probability of abuse and addiction.[1],[3] The advancements in I-phones, androids, and others have given the user the total capacity to get in charge of web-related contents at the fingertips and within seconds. As per the International Data Corporation (IDC) research report, out of 80% population among, 18–44-year-olds frequently check their cell phone after every 15 min without any reason.[3]

The posture which the individuals have adopted for versatile use of smartphone is a slumped one. Continuous gliding the mobile screen utilizing the thumb is unnatural and may lead to posture-related throbs and pains.[1],[2] Our spine has its ordinary bend and is not intended to be held in clumsy postures for extensive stretches of time, and our thumbs are not made to do such tedious undertakings, on a little screen.[1],[2],[3] The use of cell phones tends to prompt awkward head-and-neck pose than workstations.

Despite the fact that the utilization of cell phones for longer duration in the day makes life simpler, it might prompt posture, joint, and neurologic disorders. The most defenseless organ during smartphone use is eyes. As eyes are augmentation of the sensory system, visual torment might be one of the qualities of the patients who use cell phones. A few specialists have recommended that continuous cell phone use can prompt the utilization of nonaligned neck posture.[2],[3]

“Content neck” is utilized to depict redundant pressure damage or an abuse disorder where an individual has his/her head hung or flexed in a forward position and is twisted down taking a gander at his/her portable or other electronic devices.[3],[4],[5],[6]

In day-to-day life, mobile applications offer all solutions to our needs. The multiple usability options available on mobile phones encourage users to spend a considerable amount of time on their mobile phones. Long-term mobile use can lead to various musculoskeletal problems, especially neck pain associated with eye discomfort and vision disturbances. This is referred to as “smartphone adversity.” These issues are often overlooked. As a result, the current study was undertaken to evaluate the effect of strengthening the cervical muscles and training the eye muscles among the students with smartphone adversity.[3],[4]

  Materials and Methodology Top

It was an experimental study conducted in Dr. D. Y. Patil College of Physiotherapy, where the sample size was 30. The study was approved by the Institutional Ethics Committee (DYPCPT1/10/2018). Physiotherapy students having neck pain, both male and female between the age group of 18–25 years, using smartphone for an average 3 h/day since 1 year and complaining about neck pain and visual discomfort were included in the study.

Participants having chronic systematic diseases, any congenital deformity of the upper limb and neck, any recent fracture of the upper limb and neck, any recent surgery of the upper limb and neck, and participants who have undergone ocular surgeries or having any eye problems were excluded from the study. A written informed consent was obtained from the participants who fulfilled the inclusion criteria and were willing to participate in the study. The demographic information of each participant was taken, and the purpose of the study was explained to them. Pre outcome assessment was done using the ocular surface disease index (OSDI) questionnaire for visual discomfort, pressure biofeedback instrument to measure the cervical muscle strength, and visual analog scale (VAS) for assessing pain and discomfort in the neck during rest and on activity.[7],[8]

Each participant was taught individually the following exercises, which they performed on their own for the next 2 weeks, once a day for 20–25 min.

Cervical muscle-strengthening exercises in the form of neck isometrics:

  • Neck flexion: Turn your neck slightly forward and put your hand on your forehead. Consider bending your head forward while pushing back with your hand. Hold for 10 s. Repeat it five times
  • Neck extension: Hold your neck and shoulders straight and put your hands on the back of your head. Try pushing your head backward with your hands going forward. Hold for 10 s and repeat five times
  • Side bending (right): Keep your head and chin level straight. Place your right hand on your head's right side. Seek with your right hand to push your head down to your left shoulder. Hold for 10 s. Repeat for five times
  • Side bending (left): Repeat the side bending as mentioned above, but to the left side with your left hand
  • Rotation: Place the left hand on the left side of the chin. Try to rotate your head toward the left, but at the same time apply counterforce to maintain the static position of the neck. Hold for 10 s count. Repeat for five times.Continue this exercise for the right side
  • Following this, the ocular muscle training exercises were given
  • Blinking: The participant was asked to blink every 3–4 s for the next 2 min. After that, relax for a 10 s and now try not to blink for 30 s at a time for the next 2 min
  • Palming: Place your two hands over your eyes with the cup of your palm covering your eyes, your fingers on your forehead, and the heel of your hand will rest on your cheekbone. Make sure you can blink freely and you are not putting too much pressure on your eye. Do this for 30 s
  • Figure of 8: Imagine a giant figure of 8 in front of you about 10 feet. Now close one eye and trace the figure of 8 with your eyes, slowly in the horizontal direction. Repeat it for five times and then relax. Now, perform the same exercise with the other eye closed
  • Finger-targeted near-and-far focusing: Stretch out your arm with your thumb in the hitchhike position. Focus on your thumb as your arm is outstretched. Now bring your thumb closer to you, focusing all the time, until your thumb is about 3 inches in front of your face. Now, move your thumb away again until your arm is fully outstretched. Repeat this for five times at a time.

The pre assessment outcome measures were repeated again to obtain the post intervention scores.

Data analysis

The data were analyzed using WINPEPI software for windows version 4:2001. Test of normality was applied to check for the normal distribution of data (Shapiro–Wilk test). Data were not normally distributed. Hence, nonparametric test of significance was used (Wilcoxon signed-rank test) to check for the difference before and after the intervention. Data were summarized in mean and median values.

  Results Top

All the thirty participants completed the study.

[Table 1] shows the pre- and post intervention reading of the pressure biofeedback reading. Pre mean and standard deviation (SD) was 23.3 ± 1.11 and postmean and SD was 28.1 ± 1.96, respectively. There was a statistically significant difference at P < 0.05.
Table 1: Comparison of the pressure biofeedback reading

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[Table 2] shows the number of pre and post intervention OSDI score. The effect of ocular muscle training exercises was effective as the OSDI scores of the samples. The mean and SD of the participants pre intervention was 20.3 ± 5.5, which was reduced to 7.7 ± 3.07 post intervention, and there was a statistically significant difference at P < 0.05.
Table 2: Ocular surface disease index score

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[Table 3]a and [Table 3]b show the effect of neck strengthening on neck pain at rest and on activity, respectively. The symptoms of most of the patients came to normal values post treatment (P = 0.001) on the neck pain. The mean and SD for VAS on activity (7.3 ± 0.66 > 3.2 ± 0.64) and VAS on rest (4.7 ± 0.69 > 0.8 ± 0.56) signifies a decrease in the symptoms of pain pre- and post intervention. The result was statistically significant with P = 0.001 when Wilcoxon signed-rank test was applied.

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  Discussion Top

The purpose of the study was to investigate the effect of neck-strengthening exercises and ocular muscle training in smartphone users having neck pain. Neck pain is caused due to an overuse syndrome where a person has his/her head flexed in a forward position and is bent down looking at his/her smartphone for prolonged period of time.[9],[10] Hence, it is very important to train the person accordingly by setting up a physical therapy session/program which will help him to get relief from the pain. The exercise regime tended to be easy and comfortable to learn in our study as all the participants developed their ability to perform the task of exercise. Most of the participants shared a positive opinion on the exercise. There was a significant increase in the strength of the cervical muscles (P = 0.001) after the intervention. Improvement of posture has also been noted as poor posture in smartphone users is one of the causes of neck pain. Ergonomic advice was also provided to participants, which included simple lifestyle changes that significantly help to alleviate muscle pain and neck discomfort before the condition worsens, improvements in his/her attitude, and frequent breaks during the use of the mobile that help to relieve the stress on the neck and shoulders.[11]

This study also showed that the participants had signs of dry eye disease along with neck pain. Eighty-six percent of the participants had shown mild-to-moderate symptoms of the disease on the OSDI questionnaire, which reduced to normal in 90% of the participants post intervention. The direct effect of light and heat that is produced from the smartphone affects the ocular surface.[12],[13] The blinking rate is also reduced due to the smartphone's constant gazing. In her research, Sadagopan et al. reported that a person's usual blinking rate is about 15 times a minute.[12],[13] The eye muscle training given in the form of four eye exercises, namely blinking, palming, figure of 8 and fingertargeted nearandfar focusing helped to reduce the tendency to tire, blurring, and strain found in the eyes due to smartphone use.[12],[13],[14] They added to their analysis that reading in bed can disrupt the sleep cycle due to the blue light radiation from the monitor, resulting in lower melatonin levels and sleep disturbances.[12],[13],[14] Ten percent of all participants were disturbed by sleep due to the excessive use of the smartphone. Apart from neck pain, 50% of participants reported headache as a result of smartphone use. Kivanc et al. quoted that smartphone use and eye pain and headache are likely to be intertwined. It may also be due to the neck pain that also affects the head's muscles and nerves, or may be headache tension.[13],[14] There was no significant balance disruption in the participants, but Park et al. found that there is an impact of visual exhaustion induced by smartphones having an effect on healthy people's balance function.[14] Fifty-six percent of participants do not avoid using their smartphones even if they feel discomfort. This indicates that these people are more addicted to the use of smartphones and can be named as chronic victims of smartphones. AbdelHameed et al. found in their investigation that the symptom of smartphone use among university students was reduced by postural corrections combined with selected exercise training programs. The study was performed for 12 weeks, and their samples were randomly split between two groups.[14],[15] Nonetheless, we find in our study that we begin to decrease the symptoms from 1 to 2 weeks with single group. Kong et al. concluded in their study that modified cervical exercises (isometric neck exercises), consisting mainly of pulling the chin to the back of the head and strengthening the neck with posterior pressure, are of paramount importance if people wish to avoid posture due to incorrect posture habits and daily lifestyle patterns.

Sadagopan et al. recorded that males were at higher risk of developing redness, blurred vision, burning sensation, and dry eyes. Females were at a slightly higher risk of developing headache and neck and shoulder pain relative to males.[12]

It is recommended that the people in general should use eye protection during Internet use, including regular breaks and eye exercises as a preventive measure to avoid discomfort in the dominant regions of the chest, arms, tail, and visual discomfort.

The limitation of the study was that it was a before and after study. It is recommended that a randomized controlled trial with two parallel groups should be conducted and with a larger sample size.

  Conclusion Top

In this research, we found that the effect of neck-strengthening exercises and eye muscle training is effective in reducing the symptoms of neck pain and dry eye disease in smartphone users.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Miakotko L. The Impact of Smart Phones and Mobile Devices on Human Health and Life, NYU; 2016. Available from: https://www.nyu.edu/classes/keefer/waoe/miakotkol.pdf. [Last accessed on 2019 Nov 20].  Back to cited text no. 1
Kivanc SA, Budak BA, Ulusoy MO, Olcasyii OO, Yesilirmak N. Relation Between Smartphone Use and Unilateral Ocular Pain and Headache. Available from: http://dx.doi.org/10.5772/66624. [Last accessed on 2019 Nov 20].  Back to cited text no. 2
Neupane S, Ifthikar Ali UT, Mathew A. Text neck syndromesystematic review. Imperial J Int Res (IJIR) 2017;3:141-8.  Back to cited text no. 3
Kong YS, Kim YM, Shim JM. The effect of modified cervical exercise on smartphone users with forward head posture. J Phys Ther Sci 2017;29:328-31.  Back to cited text no. 4
Dol KS. Fatigue and pain related to internet usage among university students. J Phys Ther Sci 2016;28:1233-7.  Back to cited text no. 5
Kim MS. Influence of neck pain on cervical movement in the sagittal plane during smartphone use. J Phys Ther Sci 2015;27:15-7.  Back to cited text no. 6
Park YH, An CM, Moon SJ. Effects of visual fatigue caused by smartphones on balance function in healthy adults. J Phys Ther Sci 2017;29:221-3.  Back to cited text no. 7
El Aza DR, Amin DI, Mohamad GI. Effect of smartphone using duration and gender on dynamic balance. Int J Med Res Health Sci 2017;6:42-9.  Back to cited text no. 8
Shan Z, Deng G, Li J, Li Y, Zhang Y, Zhao Q. Correlational analysis of neck/shoulder pain and low back pain with the use of digital products, physical activity and psychological status among adolescents in Shanghai. PLoS One 2013;8:e78109.  Back to cited text no. 9
Sarwar M, Soomro TR. Impact of smartphones on Society. Europ J Sci Res 2013;98:216-26.  Back to cited text no. 10
Rosenfield M. Computer vision syndrome: a review of ocular causes and potential treatments. Ophthalmic Physiol Opt 2011;31:502-15.  Back to cited text no. 11
Sadagopan AP, Manivel R, Marimuthu A, Nagaraj H, Ratnam K, Taherakumar, et al. Prevalence of smartphone users at risk for developing cell phone vision syndrorme among college students. J Psychol Psychother 2017;7:3.  Back to cited text no. 12
Blair B, Gama M, Toberman M. Preavalence and risk factors for neck and shoulders musculoskeletal symptoms in users of touch screen tablet computers. Univ Nevada Las Vegas 2015;5:2320.  Back to cited text no. 13
Abdelhameed AA, Abdel-aziem AA. Exercise training and postural correction improve upper extremity symptoms among touchscreen smartphone users. Honk-Kong Physiotherapy J 2016;35:37-44.  Back to cited text no. 14
Available from: https://www.cbsnews.com/news/screen-time-digitaleye-strain/. [Last assessed on 2019 Aug 21].  Back to cited text no. 15


  [Table 1], [Table 2], [Table 3]


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