INTRODUCTION:

A smartphone is a hand held device with advanced computing capabilities such as internet communication, information retrieval, videos, social media and other application. Because of its portability, the smartphone has had a large impact on modern everyday life^[8].

Texting is the most widely used mobile data service, with 74% of all mobile phone users worldwide being active users of it. Smartphone handlers are at high danger of gaining repetitive strain injuries (RSI)^[5]. The repetitive text messaging affects the soft tissues due to repetitive motion. The incidence of musculoskeletal disorder of hand, wrist, forearm, arm and neck has been increasing all over the world due to prolonged usage of smartphone^[5]. The upper extremity musculoskeletal problems especially thumb has been lately stated for smartphone users^[7]. Long term use of smartphone causes continuous mechanical stress on tendons, muscles, and parametric tissues due to over usage of smartphones application like whatsapp, Facebook, twitter, gaming’setc.^[6].

The major risk factors by using smartphone are high task repetition, prolonged activates, forceful activates and static postures. The static repeated motion while using smartphone reduces the blood circulation prevents nutrients from being supplied to muscles leading to fatigue and pain. In addition, poor postures leads to fatigue reduced physiological functio^[4]. However, in the current scenario, students use smartphones for longer periods and more than computers because they are small, easily portable, and accessible. Due to their design that do not allow wrist and fingers to rest on the screen surface, the use of touch screen may incur further exposures to awkward neck shoulder postures and distal upper extremity^[4,6].

Despite this, there is not much literature available on the musculoskeletal problems in smartphone users. Physiotherapy is a dynamic profession though it has established theoretical and scientific base and widespread clinical applications in the restoration and maintenance and promotions of optimal physical functions. Majority of these students are using smartphone for sharing study material and their personal use^[4]. The long-term use of smartphones causes continuous mechanical stress on the tendons, muscles and parametric tissues, which can induce musculoskeletal symptoms of visual display terminal (VDT) syndrome^[1,2].

MATERIALS AND METHODS:

A total of 30 subjects with musculoskeletal disorder between age group 19-22 years participated in the study. The survey was carried out in 30 physiotherapy students in Saveetha College of physiotherapy Chennai, Tamilnadu. Subjects were asked to fill an questionnaire is made of 2 sessions, a subjective questionnaire about the hand dominance, type of smartphone used and the total hours of smartphone usage per day and the other with Cornell mobile phone hand discomfort questionnaire(CMPHDQ). VAS is used to analyze the pain score before and after the test. The study duration is about 4 daysper week for 8 week of duration. Statistical analysis and graphical representation was done with the values tabulated. The Materials required for this study are Mid-Resistance Thera bandcolor(orange).

INCLUSION CRITERIA:

Ÿ Age group under 19-22 years

Ÿ The spending time in social medias and other applications for 2 hours

Ÿ Right hand users of both male and female

Ÿ Onset of symptoms like pain, burning sensation, paresthesia

Ÿ Playing games for more than 1hour/day using smartphone

EXCLUSION CRITERIA:

Ÿ Subjects with recent injuries (less than 6 months) to the hand or extremity

Ÿ Having any deformity, degeneration, inflammation, musculoskeletal or neurological conditions of hand.

PROCEDURE:

30 subjects were selected randomly between the age group of 19-22 years. The survey was carried out with 30 physiotherapy students in Saveetha College of physiotherapy. Subjects were diagnosed with MSD were divided into two groups group A (15) subjects and group B(15) subjects to participate in the experimental study. The questionnaire is made of 2 sessions; a Subjective questionnaire was used to collect details about the hand dominance, type of Smartphone, total hours of usage per day. After the survey was completed the questionnaire was recollected. And secondly the Cornell Mobile Phone Hand Discomfort Questionnaire (CMPHDQ) is given to analyze the pain score. Based on the scale score on the questionnaire all the 30 subjects those who are divided into group A and group B. The sequenced protocol of Rehabilitation are conducted in 2 phases; phase 1 (resistance exercise for thumb), phase 2 Exercise (nerve and tendon gliding exercise for hand) received for 4 days/week in duration of 8 Weeks.

The phase 1 exercise were received by Group A subjects which includes Resistance exercise Using mid-resistance Theraband and with postural corrections. Phase exercise was received by Group B which includes nerve and tendon gliding exercise with postural corrections. Visual Analog scale (VAS) is used to assess the pain level of the study in subjects before and after the Rehabilitation phases.

RESULTS:

According to the survey,in this study 40% physiotherapy students were suffering from MSD and majority of the students have been found to use the smartphones in sitting position adopting a poor posture for prolonged time. It was found that 70% of participants use their mobile phones for more than 2 hours. The second session of Cornell mobile phone handle questionnaire Area C (Thumb area) showed the highest score of pain and discomfort in both male and female subjects. This is due to, during texting the subjects had greater muscular activity in the Abductor Pollicis longus muscle and Extensor digitorum muscle and tended to have more thumb adduction and more thumb speeds with less stops in thumb movements. The Visual analog scale shows that the Rehabilitation protocol for phase 1 (Resistance exercise) had absolute reduction of pain than the phase 2 (Nerve and Tendon gliding exercise).All the values were tabulated and statistically analyzed using unpaired test. Data analysis revealed significant difference between two groups; Group A those who received phase 1 Resistance exercise and Group B those who received phase 2 Nerve and Tendon gliding exercise. The statistical analysis for phase 1 exercise; the p value is less than 0.0001 and the t value is 7.9373. According to the Group A the mean value of pre-test is 4.53 and post-test 1.53, the SD for pre-test 2.33 and post-test 1.06 and the n=15. The Statistical analysis for phase 2, the p value is less than 0.0001 and t value is 5.8566 and the mean value of Group B at pre-test is 4.53, post-test 2.20. The SD value in pre-test is 2.33 and post-test is 1.26, n=15.

PAIN PREVALENCE IN HAND AND WRIST (CMPHDQ)

PRE-TEST

POST-TEST:

Graphical Representation for Phase 1 and 2 (Vas) (Pre-Test)

GROUP A (RESISTANCE EXERCISE WITH POSTURAL CORRECTIONS)

GROUP B (NERVE AND TENDON GLIDING EXERCISE WITH POSTURAL CORRECTIONS)

Graphical Representation for Phase 1 and 2 Post-Test

DISCUSSION:

According to the result relating to the smartphone usage questionnaire, 80.7% used for chatting, 38.2% used them for searching the internet, 12.5% used for playing games, 3.8% used for other activities. The symptoms of pain was evaluated by using VAS 27.5% of them were unaffected by mild hand pain. Studies revealed that while texting in smartphone, the posture of thumb working near the extreme range of motion which develops MSD^[10]. A study showed that postures and the type of mobile phone task affected muscle activity and thumb positions. The muscle activity in the extensor digitorum communis and the abductor pollicies longus when entering SMS messages and tended to have greater thumb movement velocities and fewer pauses in the thumb movement^[5]. Based upon the result obtained in this study it is obvious that a cell phone is essential in everyone’s life these days. From this study it has done to determine the affect regarding musculoskeletal disorder, caused by smartphones^[9]. In the long term, poor posture can damage not only the neck bones and structures around the lumbar vertebrae but also the ligaments.

Mobile phone users are at high risk of developing various repetitive strain injuries (RSI) type of condition to the soft tissues due to repetitive use of the mobile phone in text messaging i.e chatting^[4]. Musculoskeletal problems of the upper limb and especially the thumb have been reported in mobile phone users due to text messaging^[8]. The most commonly found conditions were tendinitis of extensor pollicis longus, myofacial pain syndrome of the muscles and first interossei extensor digitorom communis^[4,8]. Movement of finger is quite similar as in typing the text on mobile screen. This will affect the any of the finger and it may lead to tendinitis, bursitis etc^[4].

CONCLUSION:

It is concluded that there is a prevalence of musculoskeletal problem in physiotherapy students using smartphones and they are affected by bad postures. Although the findings of the study proves resistance exercise is more effective than nerve and tendon gliding exercise, the risk of over usage of smart phone in the current generations also raises the future risk to develop MSD problems in those heavily using smartphones for a much more longer duration. Hence the users are advised to perform the exercises along with ergonomic friendly devices that are designed to reduce MSD.

FURTHER RECOMMENDATIONS:

Further studies may be done for those who use smartphones for more than two hours per day. Different groups of samples or population may be investigated for the same study.

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Received on 03.02.2018 Modified on 26.03.2018

Research J. Pharm. and Tech 2018; 11(8): 3457-3460.

DOI: 10.5958/0974-360X.2018.00638.8