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Pain intensity, physical activity, and sedentary behavior predict text neck syndrome among Nigerian undergraduates: findings from predictive modelling

public-health
translational-medicine
rehabilitation

Abstract

Background: Text neck syndrome (TNS) is a musculoskeletal condition linked to prolonged cervical flexion during smartphone use. While commonly associated with neck pain, the interplay between pain intensity, physical activity, and sedentary behavior remains underexplored. This study examined the prevalence of TNS and identified clinical and behavioral predictors among Nigerian undergraduates.

Methods: A cross-sectional survey of 402 students was conducted using validated instruments to assess pain intensity, neck disability, physical activity, sedentary behavior, posture, and smartphone use. TNS was defined as ≥4 hours/day of smartphone use plus ≥3 characteristic symptoms. Analyses included chi-square tests, Mann–Whitney U tests, Firth logistic regression, classification tree modelling, and structural equation modelling to assess predictive and mediating relationships.

Results: TNS prevalence was 85.1%. Students with TNS reported significantly higher smartphone use, pain intensity, sedentary time, and neck disability scores (all p < 0.05). In multivariate analysis, pain intensity was the strongest predictor (OR = 23.86, 95% CI = 16.90–56.99), perfectly classifying TNS (AUC = 1.00). Other predictors lost significance when pain was included. Structural equation modelling showed physical activity had a small protective effect (β = 0.106, p = 0.001), sedentary behavior had a negative effect (β = -0.079, p = 0.031), and sedentary behavior partially mediated the pain–TNS relationship (indirect β = -0.019, p < 0.05). No moderation effect was observed.

Conclusions: TNS is highly prevalent among Nigerian undergraduates, with pain intensity overshadowing other risk factors. Findings support early physiotherapy-led screening for neck pain, ergonomic education, and behavioral interventions to reduce sedentary time.

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