Neck and shoulder strains under various head flexing positions while standing and sitting with and without back support for male and female smartphone users.

This study recruited 30 young participants (15 men and 15 women) to examine the smartphone usage patterns in three postures (standing, supported sitting, and unsupported sitting) and at five head angle (HA) positions (0°-40°). Cervical erector spinae (CES) and upper trapezius (UTZ) muscle activity, neck flexion (NF), gaze angle (GA), viewing distance (VD), and discomfort scores were collected. Results showed that HA and posture almost affected all responses, while CES muscle activity, NF, and VD differed between sexes. Strain in the neck and shoulder region increased with HA increase. Particularly, when the HA exceeded 20°, the discomfort scores considerably increased. Unsupported sitting should be avoided during smartphone use because of relatively poor responses in all variables. However, both standing and supported sitting have their respective benefits. Sex-related differences were typically observed in the standing position, with women tending to have lower NF but higher CES muscle activity compared with men. Although smartphones have become daily necessities, the overall quantitative neck and shoulder strain of using smartphones in different postures is rarely evaluated. We suggest that maintaining the HA within 20° is recommended because of relatively low load on the neck and shoulders. An unsupported sitting should be avoided during smartphone use.