Effects of Exercise Training Delivered Through Telerehabilitation on Text Neck Syndrome

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.

• Telerehabilitation-Based Neck Exercise Training (Behavioral): Participants received a 6-week Telerehabilitation exercise program delivered via video calls and digital platforms, three sessions per week. The program included stretching, active range of motion, isometric strengthening, and postural correction exercises with progressive intensity.
• Supervised physiotherapy exercise training (Behavioral): Participants received the same 6-week exercise program as the Telerehabilitation group, but delivered face-to-face in a supervised clinical setting by a physiotherapist, three sessions per week.

Primary outcomes

• The Extensor Endurance Test [baseline, immediately after the intervention]: The Extensor Endurance Test was conducted in prone position, with the participant asked to hold the head in a neutral position with the chin tucked. Time to fatigue (in seconds) was recorded for both tests
• The Neck Flexor Endurance [baseline, immediately after the intervention]: The Neck Flexor Endurance Test was performed in a semi-supine position, with the participant instructed to lift and hold the head at 2.5 cm above the table surface until fatigue

Secondary outcomes

• Neck Disability Index [baseline, immediately after the intervention]: The NDI consisted of 10 items assessing neck-related functional limitations, with a maximum score of 50, higher scores indicating greater disability.
• Numeric Rating Scale [baseline, immediately after the intervention]: The NRS ranged from 0 (no pain) to 10 (worst imaginable pain) and was administered pre- and post-intervention.

Sex: All, ages: 18 Years to 24 Years, accepts healthy volunteers

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.