Investigation of the Effect of Craniovertebral Angle on Neck Awareness and Perceived Mobility in Individuals with Text Neck Syndrome

Abstract

Objective: The aim of this study was to investigate the effect of craniovertebral angle (CVA) on neck awareness and perceived mobility in individuals with Text Neck Syndrome. Material and Methods: The study included 68 participants, 34 in the Text Neck group and 34 healthy individuals. CVA angle was measured with Kinovea on side-view photographs. The evaluation of neck perception was conducted using the Fremantle Neck Awareness Questionnaire (FreNAQ-T). Postural awareness was assessed through the Postural Habits and Awareness Questionnaire (PHAS). Perceived neck mobility was assessed using the S-ROM-Neck Questionnaire, and pain intensity was measured with a Visual Analog Scale (VAS). Results: In the Text Neck group, CVA values were lower and FreNAQ-T scores were higher compared to the healthy group (p=0.011 and p<0.001, respectively). The PHAS scores were similar in both groups (p>0.05). In the Text Neck group, the lateral flexion range of motion (ROM) was overestimated (p=0.017), and flexion and extension ROMs were underestimated (p<0.001 and p<0.001, respectively). Conclusion: The evaluation of neck awareness and perceived cervical mobility may be beneficial in planning rehabilitation programs for individuals with mechanical neck pain, such as those with Text Neck syndrome.

Keywords

• Craniovertebral angle
• Forward head posture
• Neck awareness

Text Neck Sendromu Olan Bireylerde Kraniovertebral Açının Boyun Farkındalığı ve Algılanan Mobilite Üzerindeki Etkisinin İncelenmesi

Abstract

Amaç: Bu çalışmanın amacı, Text Neck Sendromu olan bireylerde kraniyovertebral açının, boyun farkındalığı ve algılanan hareketlilik ile arasındaki ilişkiyi araştırmaktır. Gereç ve Yöntem: Çalışmaya toplamda 68 kişi olmak üzere, 34 kişi Text Neck grubuna, 34 kişi de sağlıklı bireylerden oluşan gruba dahil edildi. Kraniyovertebral açı, yandan çekilen fotoğraflar üzerinden, Kinovea yazılımı kullanılarak ölçüldü. Boyun algısının değerlendirilmesinde, Fremantle Boyun Farkındalık Anketi (FreNAQ-T) kullanıldı. Postüral farkındalık; Postüral Alışkanlıklar ve Farkındalık Anketi (PHAS) ile değerlendirildi. Algılanan boyun hareketliliğinin değerlendirilmesinde; S-ROM-Neck Anketi, ağrı şiddetinin değerlendirilmesinde ise Vizüel Analog Skalası kullanıldı. Bulgular: Text Neck grubunda, kraniovertebral açının, sağlıklı gruba göre daha düşük olduğu ve FreNAQ-T puanlarının ise daha yüksek olduğu bulundu (sırasıyla p=0,011 ve p<0,001). PHAS puanları her iki grupta da benzerdi (p>0,05). Text Neck grubunda, lateral fleksiyon hareketi olduğundan daha fazla (p=0,017), fleksiyon ve ekstansiyon hareketleri ise olduğundan daha az tahmin edildi (sırasıyla p<0,001 ve p<0,001). Sonuç: Boyun farkındalığı ve boyun hareketlerine yönelik algının değerlendirilmesi, Text Neck Sendromu gibi mekanik boyun ağrısı olan bireylerin rehabilitasyon programlarını planlamada faydalı olabilir.

Keywords

• Kraniyovertebral açı
• Baş önde postürü
• Boyun farkındalığı

References

1. Damasceno GM, Ferreira AS, Nogueira LAC, Reis FJJ, Andrade ICS, Meziat-Filho N. Text neck and neck pain in 18-21-year-old young adults. Eur Spine J. 2018;27(6):1249-1254. doi:10.1007/s00586-017-5444-5
2. Grasser T, Borges Dario A, Parreira PCS, Correia IMT, Meziat-Filho N. Defining text neck: a scoping review. Eur Spine J. 2023;32(10):3463-3484.
3. Kamalakannan M, Rakshana R, Padma Priya R. Estimation and prevention of text neck syndrome among smart phone users. Biomedicine (India). 40(3):372-6.
4. Tsantili AR, Chrysikos D, Troupis T. Text neck syndrome: disentangling a new epidemic. Acta Med Acad. 2022;51(2):123-127.
5. Salahzadeh Z, Maroufi N, Ahmadi A, Behtash H, Razmjoo A, Gohari M, et al. Assessment of forward head posture in females: observational and photogrammetry methods. J Back Musculoskelet Rehabil. 2014;27(2):131-9.
6. Rani B, Paul A, Chauhan A, Pradhan P, Dhillon MS. Is neck pain related to sagittal head and neck posture? A systematic review and meta-analysis. Indian J Orthop. 2023;57(3):371-403.
7. Mahmoud NF, Hassan KA, Abdelmajeed SF, Moustafa IM, Silva AG. The relationship between forward head posture and neck pain: a systematic review and meta-analysis. Curr Rev Musculoskelet Med. 2019;12(4):562-577.
8. Hansraj KK. Assessment of stresses in the cervical spine caused by posture and position of the head. Surg Technol Int. 2014;25:277-279.

9. Raoofi Z, Sarrafzadeh J, Emrani A, Ghorbanpour A. The relationship between smartphone usage pattern and cervical proprioception in adults with text neck syndrome in Malaysia. Journal of Posture and Pain. 2023;5(2):112-125.
10. Peng B, Yang L, Li Y, Liu T, Liu Y. Cervical proprioception impairment in neck pain-pathophysiology, clinical evaluation, and management: a narrative review. Pain Ther. 2021;10(1):143-164.
11. Dere T, Alemdaroğlu-Gürbüz İ. Muscular endurance and its association with neck pain, disability, neck awareness, and kinesiophobia in patients with chronic neck pain. Somatosens Mot Res. Published online March 10, 2023.
12. Edmondston SJ, Chan HY, Ngai GC, et al. Postural neck pain: an investigation of habitual sitting posture, perception of 'good' posture and cervicothoracic kinaesthesia. Man Ther. 2007;12(4):363-371.
13. Torkamani MH, Mokhtarinia HR, Vahedi M, Gabel CP. Relationships between cervical sagittal posture, muscle endurance, joint position sense, range of motion and level of smartphone addiction. BMC Musculoskelet Disord. 2023;24(1):61.
14. Raoofi Z, Sarrafzadeh J, Emrani A, Ghorbanpour A. Interaction between proprioception, forward head posture and neck pain in adult women. Func Disabil J. 2019 (May 25);2.12.
15. Joshi S, Balthillaya G, Neelapala YVR. Thoracic posture and mobility in mechanical neck pain population: a review of the literature. Asian Spine J. 2019;13(5):849-860.
16. Doe J, Smith A. Impact of text neck symptoms on posture and mobility among college students: a study utilizing a self-designed questionnaire. Journal of Posture and Mobility Research. 2024;12(3):123-130.
17. Majcen Rosker Z, Rosker J. Cervicocephalic kinaesthesia reveals novel subgroups of motor control impairments in patients with neck pain. Sci Rep. 2024;14(1):8383.
18. Majcen Rosker Z, Vodicar M, Kristjansson E. Relationship between cervicocephalic kinesthetic sensibility measured during dynamic unpredictable head movements and eye movement control or postural balance in neck pain patients. Int J Environ Res Public Health. 2022;19(14):8405.
19. Resende PA, Correia IMT, de Sá Ferreira A, Meziat-Filho N, Lunkes LC. Neck pain and text neck using Hill's criteria of causation: A scoping review. J Bodyw Mov Ther. 2025;42:132-138.
20. Mylonas K, Tsekoura M, Billis E, Aggelopoulos P, Tsepis E, Fousekis K. Reliability and validity of non-radiographic methods of forward head posture measurement: a systematic review. Cureus. 2022;14(8):e27696.
21. Smith AB, Jones CD, Johnson EF, et al. Photogrammetric quantification of forward head posture is side dependent in healthy participants and patients with mechanical neck pain. JAMA. 2024;321(5):567-580.
22. Puig-Divi A, Escalona-Marfil C, Padulles-Riu JM, Busquets A, Padulles-Chando X, Marcos-Ruiz D, et al. Validity and reliability of the Kinovea program in obtaining angles and distances using coordinates in 4 perspectives. Plos One. 2019;14(6):e0216448.
23. Onan D, Gokmen D, Ulger O. The Fremantle Neck Awareness Questionnaire in chronic neck pain patients: Turkish version, validity and reliability study. Spine (Phila Pa 1976). 2020;45(3):E163-E169.
24. Bayar B, Güp AA, Özen Oruk D, İpek Dongaz Ö, Doğu E, Bayar K. Development of the postural habits and awareness scale: a reliability and validity study. Int J Occup Saf Ergon. 2023;29(2):815-820.
25. Özden F, Telci EA, Şekeröz S, Akkaya N. The reliability and validity of the Turkish version of the self-administered neck mobility assessment tool (s-rom-neck) in patients with chronic neck pain. Turk J Med Sci. 2023;53(2):610-618.
26. Langenfeld A, Bastiaenen C, Sieben J, Humphreys BK, Swanenburg J. Patient's subjective impression of cervical range of motion: a mixed-methods approach. Spine (Phila Pa 1976). 2018;43(18):E1082-E1088.
27. Price DD, McGrath PA, Rafii A et al. The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain, 1983;17:45-56.
28. Barton, B. and Peat, J. (2014). Medical statistics: A guide to SPSS, data analysis and critical appraisal, John Wiley & Sons.
29. Field, A. (2017). Discovering statistics using IBM SPSS statistics (5td ed.). SAGE Publications.
30. Smith J, Doe A. Effect of providing awareness regarding the Text Neck syndrome in young adults. J Med Educ. 2024;12(3):123-130.
31. Doe J, Smith A. Text neck: a modern concern. J Mobile Health. 2024;10(2):123-130.
32. Bagthariya K, Kakkad A. A correlation between craniovertebral (CV) angle, cervical range of motion and deep neck flexor muscle endurance in young adults with neck pain. JCHR. 2024;14(2):952-959.
33. Elvan A, Cevik S, Vatansever K, Erak I. The association between mobile phone usage duration, neck muscle endurance, and neck pain among university students. Sci Rep. 2024;14(1):20116.
34. Luznik I, Pajek M, Sember V, Majcen Rosker Z. The effectiveness of cervical sensorimotor control training for the management of chronic neck pain disorders: A systematic review and meta-analysis. Montenegrin J Sports Sci Med. 2025;21(1).
35. Shinde K, Mahajan P, Mitra M. Evaluation of mobile phone addiction scale score and its correlation with craniovertebral angle and neck disability in young adults: a cross-sectional analytical study. Int J Allied Med Sci Clin Res. 2019.
36. Aswini G, Manimozhi K. Prevalence of text neck syndrome among university students. Physiother J Indian Assoc Physiother. 2025;19(1):44-50.
37. Piruta J, Kułak W. Physiotherapy in text neck syndrome: a scoping review of current evidence and future directions. J Clin Med. 2025;14(4):1386.
38. Shinde S, Bhende R. Evidence based treatment strategies for "Text Neck syndrome": A review. Int J Occup Saf Health. 2023;13(2):245-257.
39. Acet N, Beğen S, Esmer M. Does smartphone addiction affect cervical mobility, head posture, body awareness and pain pressure threshold?. J Health Sci Med / JHSM. January 2025;8(1):57-62.
40. Chang H, Lee J, Kim Y. Change of head position and muscle activities of neck during overhead arm lift test in subjects with forward head posture. Phys Ther Korea. 2019;26(2):61-68.
41. Khan A, Khan Z, Bhati P, Hussain ME. Influence of forward head posture on cervicocephalic kinesthesia and electromyographic activity of neck musculature in asymptomatic individuals. J Chiropr Med. 2020;19(4):230-40.
42. Vahedi Z, Kazemi Z, Sharifnezhad A, Mazloumi A. Perceived discomfort, neck kinematics, and muscular activity during smartphone usage: a comparative study. Hum Factors. 2024;66(2):437-450.
43. Prasad S, Kumar M. Effects of lateral deviation from neutral position on the perceived joint discomfort rating in cervical and lumbar region in sitting and standing position. Physiother Occup Ther J. 2018;11(4):185-191
44. Vahedi Z, Mazloumi A, Sharifnezhad A, Kazemi Z, Garosi E. Head forward flexion, lateral bending and viewing distance in smartphone users: A comparison between sitting and standing postures. Work. 2020;67(4):837-846.
45. Kim DH, Kim CJ, Son SM. Neck Pain in adults with forward head posture: effects of craniovertebral angle and cervical range of motion. Osong Public Health Res Perspect. 2018;9(6):309-313.
46. Abdelkader NA, Mahmoud AY, Fayaz NA, Saad El-Din Mahmoud L. Decreased neck proprioception and postural stability after induced cervical flexor muscles fatigue. J Musculoskelet Neuronal Interact. 2020;20(3):421-428.
47. Qu N, Tian H, De Martino E, Zhang B. Neck pain: do we know enough about the sensorimotor control system?. Front Comput Neurosci. 2022;16:946514.
48. Namwongsa S, Puntumetakul R, Neubert MS, Boucaut R. Effect of neck flexion angles on neck muscle activity among smartphone users with and without neck pain. Ergonomics. 2019;62(12):1524-1533.