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Ehsan Naeimi
Gholam Reza Olyaei
Mohammad Reza Hadian
Saeed Talebian
Roya Khanmohammadi


McKenzie exercises, Kinesio taping, muscle fatigue, musculoskeletal disorders, smartphone users


Background: Using smartphones has increased dramatically; however, it causes the incidence of neck musculoskeletal disorders. Muscles fatigue is a predictive biomarker and precursor of neck musculoskeletal disorders. Accordingly, this study aims to compare the effect of McKenzie exercises and Kinesio taping on the fatigue of some cervical muscles while texting with a smartphone.

Methods: This was a randomized controlled single-blinded trial. Twenty-four smartphone users participated in this crossover study. All 24 subjects were experimented with the McKenzie, taping and control groups conditions. Root mean square and median frequency of the right and left upper trapezius, cervical erector spinae, and sternocleidomastoid muscles was measured during 30 min of texting with a smartphone. A 90-s break was considered in the middle of the task. Interrupted time series design and joint analysis of spectrum and amplitude methods was used for analyzing electromyography data. 

Results: In contrast to the other two groups, cervical muscles fatigue did not occur in the last 15 min of the task in the McKenzie group. Compatibly, in the McKenzie group, the median frequency coefficient of determination of all muscles, except the left cervical erector spinae, was significantly different from the control group in the last 15 min of the task (P < 0.001).

Conclusion: The McKenzie exercises can prevent or even improve cervical muscles fatigue caused by texting with a smartphone. Consequently, it can help prevent neck musculoskeletal disorders related to smartphone texting like text neck syndrome.

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1. Ratan, Z.A., et al., Smartphone overuse: A hidden crisis in COVID-19. Health Policy Technol, 2021. 10(1): p. 21-22.
2. Gustafsson, E., et al., Texting on mobile phones and musculoskeletal disorders in young adults: a five-year cohort study. Applied ergonomics, 2017. 58: p. 208-214.
3. Toh, S.H., et al., A prospective longitudinal study of mobile touch screen device use and musculoskeletal symptoms and visual health in adolescents. Appl Ergon, 2020. 85: p. 103028.
4. Xie, Y., G. Szeto, and J. Dai, Prevalence and risk factors associated with musculoskeletal complaints among users of mobile handheld devices: A systematic review. Appl Ergon, 2017. 59(Pt A): p. 132-142.
5. Fiebert, I., et al., Text neck: an adverse postural phenomenon. Work, 2021. 69: p. 1261-70.
6. Areeudomwong, P., et al., Effects of Shoulder Taping on Discomfort and Electromyographic Responses of the Neck While Texting on a Touchscreen Smartphone. Saf Health Work, 2018. 9(3): p. 319-325.
7. Areeudomwong, P., et al., Effects of kinesio taping on neck-shoulder discomfort and EMG responses during smartphone texting in healthy young adults. Work, 2020. 67(4): p. 847-854.
8. Sarker, P., et al., Effects of break scheduling strategies on subjective and objective measures of neck and shoulder muscle fatigue in asymptomatic adults performing a standing task requiring static neck flexion. Appl Ergon, 2021. 92: p. 103311.
9. Kase, K., J. Wallis, and T. Kase, Clinical Therapeutic Applications of the Kinesio Taping Methods. 2003, Tokyo: Kinesio Taping Assoc.
10. Alam, S., et al., Immediate effect of Kinesio taping on shoulder muscle strength and range of motion in healthy individuals: A randomised trial. Hong Kong Physiother J, 2015. 33(2): p. 80-88.
11. McKenzie, R., Treat Your Own Neck. 2006: Spinal Publications.
12. McKenzie, R. and S. May, The cervical & thoracic spine: mechanical diagnosis & therapy. 2nd ed. 2006: Spinal Publications.
13. Mousavi-Khatir, R., et al., The effect of static neck flexion on mechanical and neuromuscular behaviors of the cervical spine. J Biomech, 2018. 72: p. 152-158.
14. Pashine, A.A., S. Jethani, and S. Chourasia, Does Smartphone Use Really Impact Cervical Rotation and Cervical Proprioception in Asymptomatic Individuals? Cureus, 2023. 15(4): p. e37170.
15. Korakakis, V., et al., Repeated end range spinal movement while seated abolishes the proprioceptive deficit induced by prolonged flexed sitting posture. A study assessing the statistical and clinical significance of spinal position sense. Musculoskeletal Science and Practice, 2017. 31: p. 9-20.
16. Hägg, G.M., A. Luttmann, and M. Jäger, Methodologies for evaluating electromyographic field data in ergonomics. J Electromyogr Kinesiol, 2000. 10(5): p. 301-12.
17. Turner, S.L., et al., Design characteristics and statistical methods used in interrupted time series studies evaluating public health interventions: a review. J Clin Epidemiol, 2020. 122: p. 1-11.
18. Mousavi, S.J., et al., Translation and validation study of the Iranian versions of the Neck Disability Index and the Neck Pain and Disability Scale. Spine, 2007. 32(26): p. E825-E831.
19. MacDermid, J.C., et al., Measurement properties of the neck disability index: a systematic review. J Orthop Sports Phys Ther, 2009. 39(5): p. 400-17.
20. Bababekova, Y., et al., Font Size and Viewing Distance of Handheld Smart Phones. Optometry and vision science : official publication of the American Academy of Optometry, 2011. 88: p. 795-7.
21. Williams, E., Experimental Designs Balanced for the Estimation of Residual Effects of Treatments. Australian Journal of Chemistry, 1949. 2: p. 149-168.
22. Hermens, H.J., et al., Development of recommendations for SEMG sensors and sensor placement procedures. Journal of Electromyography and Kinesiology, 2000. 10(5): p. 361-374.
23. David C. Preston, B.E.S., Electromyography and Neuromuscular Disorders. 3rd ed. 2013: Elsevier Inc.
24. Lim, E.C. and M.G. Tay, Kinesio taping in musculoskeletal pain and disability that lasts for more than 4 weeks: is it time to peel off the tape and throw it out with the sweat? A systematic review with meta-analysis focused on pain and also methods of tape application. Br J Sports Med, 2015. 49(24): p. 1558-66.
25. Søgaard, K., et al., The effect of sustained low-intensity contractions on supraspinal fatigue in human elbow flexor muscles. J Physiol, 2006. 573(Pt 2): p. 511-23.
26. Amann, M., Central and peripheral fatigue: interaction during cycling exercise in humans. Medicine & Science in Sports & Exercise, 2011. 43(11): p. 2039-2045.
27. Monjo, F., R. Terrier, and N. Forestier, Muscle fatigue as an investigative tool in motor control: A review with new insights on internal models and posture-movement coordination. Hum Mov Sci, 2015. 44: p. 225-33.
28. Mousavi-Khatir, R., et al., Disturbance of neck proprioception and feed-forward motor control following static neck flexion in healthy young adults. Journal of Electromyography and Kinesiology, 2018. 41: p. 160-167.
29. Henneman, E., Relation between size of neurons and their susceptibility to discharge. Science, 1957. 126(3287): p. 1345-7.
30. Côté, J.N., Adaptations to neck/shoulder fatigue and injuries. Adv Exp Med Biol, 2014. 826: p. 205-28.
31. Madeleine, P., On functional motor adaptations: from the quantification of motor strategies to the prevention of musculoskeletal disorders in the neck-shoulder region. Acta Physiol (Oxf), 2010. 199 Suppl 679: p. 1-46.