In recent years, the widespread adoption of smartphones has significantly transformed communication, entertainment, and learning. These devices have become an indispensable part of daily life, especially among college students, who rely on them for academic purposes, social interactions, and leisure activities(1). However, the extensive use of smartphones has been associated with several health concerns, one of the most prominent being neck pain, often referred to as "text neck." This term describes the discomfort and pain that arise from prolonged forward head posture, which is commonly adopted during smartphone use(2).

Neck pain is a prevalent musculoskeletal disorder characterized by discomfort, stiffness, and functional limitations in the cervical region. Various factors, including posture, ergonomic setup, and lifestyle habits influence it. The risk of developing neck pain has become a growing concern among college students, who typically spend hours engaged in smartphone activities such as texting, browsing, and gaming. Studies indicate that poor posture, particularly the forward head posture, places excessive strain on the cervical spine and surrounding musculature, leading to pain and potential long-term musculoskeletal issues(3).

The neck, or cervical region, is a complex anatomical structure that supports the head, facilitates movement, and houses critical neurovascular structures. It comprises the cervical spine, a series of seven vertebrae labeled C1 through C7. These vertebrae are smaller and more mobile compared to other parts of the spine, allowing for a wide range of motion including flexion, extension, rotation, and lateral bending. The first cervical vertebra, the atlas, supports the skull and articulates with the occipital bone, while the second vertebra, the axis, allows for the rotational movement of the head(4).

Intervertebral discs, composed of a soft nucleus pulposus surrounded by a tough annulus fibrosus, lie between each vertebra. These discs act as cushions, absorbing shock and providing flexibility to the cervical spine. The cervical spine also features facet joints, which are paired synovial joints located at the back of each vertebra. These joints contribute to the stability of the spine and allow smooth movements. The cervical vertebrae protect the spinal cord, which descends from the brain through the vertebral canal and transmits neural signals to the rest of the body(5).

The neck’s musculature is divided into two main groups: superficial and deep muscles. The superficial muscles, such as the sternocleidomastoid and trapezius, are responsible for larger movements like turning the head or shrugging the shoulders. The sternocleidomastoid, in particular, plays a crucial role in flexing the neck and rotating the head. The deeper layer consists of smaller muscles like the scalenes, levator scapulae, and the suboccipital muscles, which provide stability and fine control of head movements(6).

Ligaments, including the anterior and posterior longitudinal ligaments, and the ligamentum nuchae, further stabilize the cervical spine by limiting excessive movement and maintaining alignment. The cervical region also contains an intricate network of nerves, such as the cervical plexus and brachial plexus, which emerge from the spinal cord and innervate the neck, shoulders, and upper limbs. The vagus nerve, a major cranial nerve, also passes through this region, influencing autonomic functions such as heart rate and digestion(7).

The link between smartphone usage and neck pain has been the focus of several recent studies, highlighting the role of excessive screen time, poor ergonomic practices, and inadequate physical activity in developing cervical discomfort. Despite this growing body of evidence, there is still limited research focusing specifically on the college student population, who are at a higher risk due to their unique usage patterns and academic demands. Understanding the relationship between smartphone use and neck pain in this demographic is crucial for developing effective preventive strategies and promoting healthy device use habits(8,9).