Problematic smartphone use predicts musculoskeletal symptoms in university students: the distinct roles of addiction vs. usage duration

Aims: This study aimed to determine the prevalence of problematic smartphone use among university students and to examine whether addiction scores or daily usage duration is more strongly associated with musculoskeletal symptoms, posture, and related habits. Methods: A cross-sectional study was conducted between September and November 2022 on 207 university students. Data were collected via an online survey including demographic information, the Smartphone Addiction Scale-Short Version (SAS-SV), and the Modified Nordic Musculoskeletal Questionnaire (mNMQ). Statistical analyses included descriptive statistics, Cronbach's Alpha, Pearson correlation, multiple linear regression, and Independent samples t-test. The significance level was set at p<0.05. Results: The prevalence of high-risk smartphone addiction was 48.8%. The vast majority (90.8%) of participants used their phones in a non-neutral, forward-flexed posture. Problematic use was significantly and positively correlated with the number of musculoskeletal symptom regions (r=0.164 for 12-month and r=0.186 for seven-day prevalence; p<0.05). In the regression model, female gender was the strongest predictor of a higher number of symptoms (β=-0.264, p<0.001). Addiction scores were significantly higher in students whose symptoms caused functional interference in daily life (p=0.001). Daily usage duration was not a significant predictor of symptoms in the multivariate analysis. Conclusion: The findings indicate that addictive behaviors and associated poor postural habits, rather than mere usage duration, are more closely linked to musculoskeletal symptoms in university students. Interventions should therefore target problematic usage patterns and postural awareness, rather than solely focusing on screen time reduction.