Smartphone-Associated Musculoskeletal Syndrome (SAMS): Characterization of a Novel Clinical Entity and Evidence-Based Physiotherapy Management Framework

Abstract

Background: Prolonged smartphone use has emerged as a significant but under characterized etiology of musculoskeletal dysfunction. While individual conditions such as "text neck" have been documented, no unified clinical framework defining Smartphone-Associated Musculoskeletal Syndrome (SAMS) with integrated physiotherapy management pathways has been established.

Objective: To characterize SAMS as a distinct clinical syndrome encompassing cervical, thoracic, upper extremity, and postural manifestations, and to develop a structured, evidence-based physiotherapy management framework tailored to this population.

Methods: A mixed-methods design was employed, combining a systematic review of literature (2012–2024) across PubMed, CINAHL, PEDro, and Scopus databases with prospective clinical data collected from 214 participants (18–45 years) presenting with smartphone-related musculoskeletal complaints. Outcome measures included the Neck Disability Index (NDI), Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, Numeric Pain Rating Scale (NPRS), cervical range of motion (CROM) goniometry, pinch and grip dynamometry, and postural photogrammetry.

Results: Three SAMS phenotypes were identified: (1) Cervicothoracic-Dominant, (2) Upper Extremity-Dominant, and (3) Mixed Postural. Physiotherapy intervention comprising postural re-education, cervical motor control retraining, deep cervical flexor (DCF) strengthening, thoracic mobilization, and hand-wrist rehabilitation over 8 weeks produced statistically significant improvements across all phenotypes (p < 0.001). The Mixed Postural phenotype demonstrated the greatest functional impairment and the longest recovery trajectory.

Conclusions: SAMS constitutes a clinically meaningful syndrome warranting phenotype-specific physiotherapy management. This paper presents the first comprehensive, structured physiotherapy framework for SAMS, offering practical clinical implementation guidelines.

Keywords: Smartphone Use; Musculoskeletal Disorders; Text Neck; Physiotherapy; Cervical Spine; Upper Extremity; Postural Dysfunction; Deep Cervical Flexors; Mobile Technology Health Effects

Citation

Muthukrishnan P, Rajadurai. Smartphone-Associated Musculoskeletal Syndrome (SAMS): Characterization of a Novel Clinical Entity and Evidence Based Physiotherapy Management Framework. WebLog J Phys Ther Rehabil. wjptr.2026.e1305. https://doi.org/10.5281/zenodo.20211385