International Journal of Industrial Ergonomics 48 (2015) 10e15

Contents lists available at ScienceDirect

International Journal of Industrial Ergonomics

journal homepage: www.elsevier.com/locate/ergon

Neck kinematics and muscle activity during mobile device operations

Xiaopeng Ning*, Yuping Huang 1, Boyi Hu 2, Ashish D. Nimbarte 3
The Ergonomics Laboratory, Department of Industrial and Management Systems Engineering, West Virginia University, Morgantown, WV 26506, USA

a r t i c l e i n f o a b s t r a c t

Article history: Neck pain is a signicant health problem due to its high incident rates and economic costs. Increased use
Received 13 August 2014 of touch screen mobile devices is becoming pervasive in the modern society and may further inuence
Received in revised form this already prevalent health problem. However, our current understanding of the cervical spine
1 February 2015
biomechanics during the operation of touch screen mobile devices is very limited. This study evaluated
Accepted 6 March 2015
the neck extensor muscle activities and the kinematics of the cervical spine during the operation of a
Available online 30 March 2015
touch screen tablet and a smart phone. Three-variables, DEVICE, LOCATION and TASK were treated as the
independent variables. NASA TLX revealed that Gaming was the least difcult task and Typing was
Keywords:
Mobile device
the most difcult task. Participants of this study maintained signicantly deeper neck exion when
Ofce ergonomics operating a smart phone (44.7
), with the mobile devices set on a table (46.4
), and while performing a
Touchscreen Typing task (45.6
). Lower levels of neck muscle activities were observed while performing a Reading
EMG task and holding mobile devices with hand. Lower levels of neck muscle activities were also observed
Kinematics when using a smart phone vs. a tablet, however such change was statistically insignicant.
Relevance to industry: The current study demonstrated that users maintain deep neck exion when using
touchscreen mobile devices. In the recent years, there is an increasing popularity of mobile smart devices
in various occupational environments. The ndings of this study may be useful in implementing human-
centered task designs to reduce neck injury risks among mobile device users.
2015 Elsevier B.V. All rights reserved.

1. Introduction pain could also decrease the stability of the cervical spine
(Lindstrm et al., 2011).
In industrialized countries, neck pain is a signicant musculo- Previously, a number of risk factors that could contribute to the
skeletal disorder (MSD) with high medical costs, social costs occurrence of neck pain have been identied. These risk factors can
(Borghouts et al., 1999) and low rate of complete recovery (Cote be generally categorized as individual factors, work-related factors
et al., 2004). Previous studies have discovered high prevalence of and psychosocial factors. The major individual risk factors that are
neck pain among the general population (Makela et al., 1991; Bovim associated with neck pain are gender and previous history of neck
et al., 1994; Croft et al., 2001; Sim et al., 2006) and among computer complaints. Epidemiological studies discovered that females have
users (Kamwendo et al., 1991; Chiu et al., 2002; Eltayeb et al., 2009). signicantly higher incidence rates of neck pain than males (Brandt
Neck pain reduces one's neck rotation range of motion and alters et al., 2004; Andersen et al., 2008). History of neck pain is another
neck muscle activation patterns (Johnston et al., 2008). The predictive individual factor for neck pain. Studies have shown that
impairment of neck muscle motor performance caused by neck neck pain is more likely to occur among individuals that have
experienced it before (Jensen, 2003; Eltayeb et al., 2009). The as-
sociation between work-related factors and neck pain has also been
investigated (Ariens et al., 2000). Previous studies concluded that
* Corresponding author. Industrial and Management Systems Engineering, P.O. prolonged neck exion is highly associated with neck pain both
Box 6070, West Virginia University, Morgantown, WV 26506, USA. Tel.: 1 304 293
9436; fax: 1 304 293 4970.
among the general population (Sim et al., 2006) and among the
E-mail addresses: [email protected] (X. Ning), [email protected]. ofce workers that use computers (Yu and Wong, 1996; Cagnie
edu (Y. Huang), [email protected] (B. Hu), [email protected] et al., 2007; Ming et al., 2004). In-vitro study suggested that hu-
(A.D. Nimbarte).
1
man neck is more vulnerable in forward exed postures than in
Tel.: 1 304 685 8931; fax: 1 304 293 4970.
2 upright neutral postures (Przybyla et al., 2007). Poor workstation
Tel.: 1 304 435 9133; fax: 1 304 293 4970.
3
Tel.: 1 304 293 9473; fax: 1 304 293 4970. design (e.g. the location of keyboard and mouse, height of

http://dx.doi.org/10.1016/j.ergon.2015.03.003
0169-8141/ 2015 Elsevier B.V. All rights reserved.
 X. Ning et al. / International Journal of Industrial Ergonomics 48 (2015) 10e15 11

computer screen) is another work-related factor that is signicantly screen size of the iPhone is 115.2 mm H  58.6 mm W  9.3 mm D,
associated with the increase of neck pain (Sillanpaa et al., 2003; and the total weight is 140 g. An iPad (2nd generation, Apple,
Korhonen et al., 2003). Previous studies have also discovered that California, USA) was used to represent a touch screen tablet. The
psychosocial factors such as increase of task difculty, psychologi- screen size of the iPad is 241 mm H  186 mm W  8.6 mm D and
cal stress, and lack of social support could increase the risk of neck the total weight is 601 g. The font sizes of both devices were set to
pain (Ariens et al., 2001; Eltayeb et al., 2009; Hush et al., 2009; system default.
Nimbarte et al., 2012).
More recently, with the increasing use of portable handheld 2.3. Experimental design
electronic devices such as touch screen tablets and smart phones,
concerns are raised regarding the poor neck posture that users may A three-variable full factorial experimental design was
employ and its potentials of causing neck and shoulder strain. One employed in the current study. The rst independent variable is
observational study showed that the majority of users maintained DEVICE, two different mobile devices were tested in the current
exed neck postures during the use of mobile devices (Gold et al., study and they were: a touch screen smart phone (i.e. iPhone) and a
2012). A recent study identied neck pain as the most severe touch screen tablet (i.e. iPad). The second independent variable was
MSD problem among mobile handheld device users (Berolo et al., the LOCATION that these mobile devices were used, there were two
2011). Two other recent studies have investigated the inuence of conditions. In the rst condition mobile devices were placed on a
different device setups on wrist, shoulder and neck postures during at table surface adjusted to the elbow height of testing partici-
the use of tablet computers (Young et al., 2012, 2013). However pants (referred to as the table condition). In the second condition,
there is still a lack of research that has quantitatively investigated participants were required to hold the device using his/her left
the neck postures and neck muscle activities during the use of hand during the operation (referred to as the handheld condi-
different mobile devices with various screen sizes. Therefore, the tion). The third independent variable was the TASK that partici-
purpose of this study was to evaluate the neck muscle activation pants were required to perform. Three different tasks were selected
levels and kinematics of the cervical spine during the use of touch and they were referred to as Reading, Typing, and Gaming
screen mobile devices. Among the three categories of previously tasks. During the Reading task, participants were required to read
identied risk factors, the current study focused on the evaluation a short paragraph of verbal material using the iBook application in
of work-related factors. The hypotheses of the current study were: the iPhone/iPad. The Typing task involved the use of the touch
(1) users will maintain deeper neck exion postures and higher screen keyboard to re-type a message that was demonstrated on
neck muscle activation levels when using mobile devices with the same screen of that mobile device. For the Gaming task,
smaller screen sizes; (2) more difcult tasks will result in deeper participants played the gaming application Fruit Ninja. This is a
neck exion postures and higher neck muscle activities. generic gaming application, and it is primarily played using the
right forenger; it involves minimum tilting and twisting of the
2. Method handheld device (Fig. 1(a)e(d)). Three dependent variables
considered in the current study were the neck exion angle, EMG
2.1. Participants activity at the left side of the cervical extensor muscle and EMG
activity at the right side of the cervical extensor muscle.
A total of fourteen right-handed participants (10 males and 4
females) were recruited for data collection in this study. All the 2.4. Protocol
participants were free from any type of MSDs and had no history of
neck injury or notable neck pain. Before data collection, the Before the experiment started, the details of data collection
experimental procedures were explained to the participants, and procedures and specic requirements of the experimental tasks
their signatures were obtained on informed consent forms which were introduced to each participant. To record the surface EMG
were approved by the local Institutional Review Board. data, the skin over the anatomical landmarks was shaved (if
needed), abraded, and cleaned with 70% alcohol, prior to the
2.2. Apparatus placement of the EMG electrodes. EMG data were recorded from
the cervical extensor (CE) muscles by placing two pairs of elec-
2.2.1. Data collection apparatus trodes bilaterally at the C4 level (Fig. 1(e)). The electrodes were
A wireless surface electromyography (EMG) system (Telemyo placed slightly inclined (approximately 35
) about 3 cm away from
2400T, Noraxon Inc., AZ, USA) was used to collect neck muscle ac- the vertical line of cervical vertebras (Nimbarte et al., 2010).
tivities. Disposable, self-adhesive Ag/AgCl snap electrodes were Postural data was recorded by using three FAB motion sensors. The
used for the signal collection. The bipolar electrodes were pre- pelvic sensor was mounted at the L5/S1 level. The trunk sensor was
gelled with 1 cm in diameter and an inter-electrode distance of mounted at the T10/T11 level. The head sensor was mounted at
2 cm. The frequency of EMG data acquisition was set at 1024 Hz. about the occipital region. Once mounted with the EMG electrodes
The cervical spine kinematics data were recorded using Func- and FAB motion sensors, participants were secured in a custom
tional Assessment of Biomechanics (FAB) (BIOSYN, Canada) system. made chair with their head exed 40
forward and performed
This full body 3D kinematic system consists of 13 small, light- maximum isometric head extension motion against a constant
weight sensors (4  7  2.4 cm) that attach to the selected body resistance. During the maximal voluntary contraction (MVC) the
areas of the user. Each sensor has a triad of accelerometer, gyro- neck extensor muscle EMG signals were recorded. Next, the FAB
meter, and magnetometer that allows real-time detection of system was calibrated. The calibration process is explained else-
angular displacement within biomechanical bodies. This is a where (Nimbarte et al., 2013).
completely wireless system and the posture data were acquired at a Upon nishing the calibration, the participants were trained for
frequency of 100 Hz. approximately 10 min to allow them get familiar with the mobile
devices and the tasks they were required to perform. Subsequently,
2.2.2. Handheld mobile devices the participants performed three repetitions for each of the 12
An iPhone (4th generation, Apple, California, USA) was used in different conditions (2 DEVICE  2 LOCATION  3 TASK) in a
the current study to represent a touch screen smart phone. The completely randomized order. The duration of each task was
12 X. Ning et al. / International Journal of Industrial Ergonomics 48 (2015) 10e15

Fig. 1. Demonstration of the four experimental conditions: (a) handheld with smart phone; (b) handheld with tablet; (c) table with smart phone; (d) table with tablet. (e)
Illustration of the locations of EMG and FAB sensors.

controlled at 90 s, during which participants were instructed to 2.6. Statistical analysis

maintain a self-selected neck posture. A 2-min rest period was
provided between the trials to avoid muscle fatigue. After the last As the rst step of the statistical analysis, the independence of
repetition of each task, participants were required to complete a observations, normality of residuals and the homogeneity of vari-
computer based NASA Task Load Index (TLX) survey to rate their ance of residuals (assumptions of the ANOVA procedures) were
perceived workload. The survey includes a total of six subscales: assessed on all dependent variables. Variables that did not satisfy
Mental Demand, Physical Demand, Temporal Demand, Per- one or more assumptions were transformed so that all assumptions
formance, Effort and Frustration. Detailed descriptions of each were satised (Montgomery, 2005). After the assumptions veri-
subscale were presented in Hart and Staveland (1988). cation, multivariate ANOVA (MANOVA) was performed to evaluate
the effect of DEVICE, LOCATION, TASK and their interactions on all
dependent variables collectively. Independent variables and inter-
2.5. Data processing and analysis
action effects that were found to be signicant were further tested
using univariate ANOVA. The TukeyeKramer post-hoc test was
EMG data were rst ltered using a 10 Hz high-pass lter and a
used to evaluate the signicant effect for variables with more than
low-pass lter of 500 Hz. A notch lter was used to eliminate
two levels. Minitab 15 statistical analysis software (Minitab Inc., PA,
ambient noise at 60 Hz and its aliases. The processed EMG data
USA) was used to perform all statistical analyses. A criteria p-value
were then fully rectied and further smoothed using a 1/8 s (128
of 0.05 was used as the signicance level.
data points) moving data window. For each muscle EMG data
collected during experimental trials were normalized to the cor-
responding maximum EMG values recorded during the MVC trials 3. Results
and presented as a percentage of the maximum. Since the neck
postures were mostly stationary during individual tasks, the neck Results of the MANOVA demonstrated signicant main effect of
muscle activation was reported in terms of normalized EMG all three independent variables (i.e. DEVICE, LOCATION and TASK)
(NEMG) averaged over the duration of 90 s. on the set of three dependent variables. However, none of the
The tasks involved in the current study required mostly sta- interaction effects were signicant. Detailed results of MANOVA
tionary sagittal neck exion without much neck rotation or laterally and univariate ANOVA are shown in Table 1.
bending. Therefore, the mean neck exion angle was selected as the The kinematic analyses revealed that the participants main-
single kinematics variable to report. The neck exion angle was tained signicantly deeper neck exion while using smart phone
dened as the sagittal angular deviation from the upright neutral (44.7
) as compared to tablet use (43.0
). The location of the device
posture. also signicantly affected the neck exion angle. Participants
Data from NASA TLX survey were processed to calculate the maintained on average 5.0
more exed neck posture when using
weighted ratings for each subscale. To obtain weighted ratings, the the mobile device on table (46.4
) than in a handheld posture
raw ratings for each subscale in the NASA TLX were multiplied by its (41.4
). This demonstrates a natural synergy between hand and
weight, i.e., the contribution of each subscale to the workload. neck in maintaining less stressful (more comfortable) head and
 X. Ning et al. / International Journal of Industrial Ergonomics 48 (2015) 10e15 13

Table 1
The results of MANOVA and univariate ANOVA.

Independent variables MANOVA ANOVA

LCE NEMG RCE NEMG Neck exion

angle

Device P < 0.001 P 0.26 P 0.05 P < 0.001

Location P < 0.001 P < 0.001 P 0.05 P < 0.001
Task P < 0.001 P < 0.001 P < 0.001 P < 0.001
Device*Location P 0.17 N/A N/A N/A
Location*Task P 0.07 N/A N/A N/A
Device*Task P 0.19 N/A N/A N/A
Device*Location*Task P 0.72 N/A N/A N/A

Note: MANOVA multivariate ANOVA; LCE left cervical extensor muscle;

RCE right cervical extensor muscle; NEMG normalized EMG.

neck postures. The neck exion angle also changed during the Fig. 3. The normalized EMG of left and right cervical extensor muscles when using
performance of different tasks. Results of the post-hoc analysis mobile devices on a table vs. handheld condition. * Denotes EMG activities that are
revealed that the Typing task introduced the deepest average statistically different between the two conditions. Bars indicate the corresponding 95%
condence interval.
neck exion angle of 45.6
; while in Gaming and Reading tasks
the neck exion angles were on average 43.6
and 42.4
respec-
tively (Fig. 2). perspective. However, larger screen size may also increase the
In general, lower muscle activity was observed for the cervical weight of the device, which could introduce fatigue to arm and
extensor muscles when using a smart phone but this difference was shoulder muscles when holding these devices for long time pe-
not statistically signicant. Signicantly higher muscle activity on riods. Larger neck exion angles (5.0
) were also observed when
the left side of the CE muscle (LCE) was observed when using the using mobile devices on a table than in handheld conditions. From
mobile device on the table than in handheld conditions (9.4% vs. our observations, using mobile devices on a table produce a larger
8.8%). A similar trend was observed on the right side of CE muscle eye-screen distance as compared to the handheld conditions. This
(RCE); however the difference was not statistically signicant may suggest that participants adopted a larger neck exion angle
(13.0% vs. 12.4%) (Fig. 3). Finally, the effect of the specic TASK was possibly as a compensatory strategy of reducing eye-screen dis-
signicant on both LCE and RCE muscles. Results of the post-hoc tance and to increase the clarity of vision.
analysis showed that both left and right muscles had signicantly NASA TLX survey has been widely used in assessing the mental
lower activation levels when performing the Reading task. workload of various human machine interaction tasks (Smith et al.,
Gaming and Typing tasks introduced higher neck extensor 2001; Vitense et al., 2003; Felton et al., 2012). In the current study,
muscle activities but the difference between these two tasks was because of the distinctive task requirements and the relatively
not statistically signicant (Fig. 4). short task performance duration (i.e. only 90 s), the NASA TLX
scores may mainly reect participants' perceived task difculty
4. Discussion (mentally and physically combined) that linked to each task's
unique visual requirements and physical interaction with the de-
Results of this study revealed that participants maintained 1.7
vices (i.e. pressing/touching vs. swiping). According to the NASA
deeper neck exion when using a smart phone in comparison to a TLX scores, Gaming was the least difcult task (with average
tablet. This result is in line with our initial hypothesis that smaller score of 34.4) followed by Reading (average score 39.6) and
screens will cause a deeper neck bending in order to reduce the Typing (average score 47.4) (Fig. 5). However, contrary to our
distance between the eyes and the screen, as well as increase the expectations, participants employed deeper neck exion and
clarity of vision. These results indicate that mobile devices with
larger screen sizes are preferable from the MSD prevention

Fig. 4. The normalized EMG of left and right cervical extensor muscles when using
Fig. 2. The average neck exion angles when using different devices, locations and mobile devices to perform different tasks. Different letters denote EMG activities that
tasks. Different letters denote angles that are statistically different from one another. are statistically different from one another. Bars indicate the corresponding 95% con-
Bars indicate the corresponding 95% condence interval. dence interval.
14 X. Ning et al. / International Journal of Industrial Ergonomics 48 (2015) 10e15

higher muscle activity during the Gaming task than the Reading activation levels from the right shoulder muscles (due to hand
task (Figs. 2 and 4) even though it was overall less difcult (Fig. 5). motions) could generate higher CE muscle activities on the same
These results suggest that task difculty is not the only determinant side. It is also possible that during the task performance partici-
for the neck exion posture. The different visual and physical pants maintained a slight leftward head bending posture, this
interaction requirements could also affect the magnitude of neck posture could also generate higher muscle activities on the
exion during the use of mobile devices. contralateral side of cervical extensors. This phenomenon has been
A previous study concluded that holding a neck exion angle of observed among lumbar muscles before (Ning et al., 2011; Hu et al.,
more than 20
for a prolonged period of time could increase the risk 2013). The higher activation level observed on the right side of the
of neck injury (Andersen et al., 2003). In the current study, the neck CE muscle indicates that operation of mobile devices with the right
exion angles maintained in all conditions clearly exceeded this hand could cause the right side of the cervical extensor muscles to
limit. Thus, prolonged use of a mobile device could pose signicant reach fatigue sooner than the left side. This elevated muscle acti-
risks for the development of neck injury. vation level may in turn increases the risk of neck dysfunction/
In the current study participants demonstrated higher muscle injury.
activation level especially on the LCE muscle when using mobile The short duration of the experimental task is the main limi-
devices on a table than in the handheld condition. There are two tation of the current study; future studies should investigate the
reasons that could explain the elevated neck muscle activation impact of prolonged mobile device usage on shoulder and cervical
levels. First, deeper neck exion posture may require larger muscle tissues. The inuence of mental workload during prolonged task
force to counterbalance the increased external moment. Second, performance should also be explored. Several other limitations
more head movements may be required for the operation when the should be noted as well. First, two specic mobile devices (i.e. the
mobile devices are kept stationary whereas in the handheld con- 2nd generation of iPad and the 4th generation of iPhone) with the
dition, hand motions could compensate for the lack of neck exion. same operation system were tested; future study may investigate
It should also be noted that the LCE muscle activity increased by a other mobile devices with different weights, operation systems and
relatively small (only 0.6%) amount. This may be due to the rela- screen sizes. Second, only three typical tasks were selected for
tively simple tasks and short durations tested in the current study. assessment in the current study. Other tasks may demonstrate
Users may demonstrate larger change in the muscle activity when different neck postures and muscle activation patterns. In addition,
performing difcult tasks of longer durations. In addition, during the neck kinematics and muscle activities recorded during the
the prolonged use of mobile devices, even small elevations of CE Gaming task may only reect the human responses for the spe-
activities could result in cumulative effects such as muscle fatigue cic or similar form of game (i.e. Fruit Ninja) tested in this study.
and other neuromuscular alternations at a much faster rate. Results Due to the large variation among different games the cervical spine
also suggest that both left and right CE muscles had the lowest kinematics and kinetics may change signicantly. Finally, among
activation levels during the Reading task, which can be attributed the three tested tasks, no specic performance requirement was
to the smallest neck exion angles maintained during this task. instructed. Future studies may test the effect of different perfor-
Both Gaming and Typing tasks showed higher neck muscle mance requirements (e.g. reaching to certain reading/typing speeds
activation levels, but there was no difference between these two or game scores). The same task with elevated requirements may
tasks. Although the neck exion angle during Gaming was not as increase the task demand and alter the physical responses of the
high as the Typing task, it was the authors observation that participants.
participants were more engaged in the task performance during
Gaming than the other two tasks. The requirement of instant 5. Conclusion
responses during Gaming tasks may have increased the CE
muscle activities. In conclusion, the current study explored the kinematic per-
In addition, it was consistently observed in our results that the formance of the cervical spine and cervical extensor muscles during
right side of the neck extensor muscle had higher activation levels the use of a touch screen tablet and a smart phone in different
compared to the left side in all conditions. In the current study, all conditions. Results demonstrated that prolonged use of mobile
participants were right-handed and they were required to use their devices exposes signicant MSD risks to the cervical spine. Spe-
right hand to operate mobile devices. It is possible that larger cically, using a smart phone on a table and performing typing task
showed the highest level of risk among all conditions tested in this
study. Cervical extensor muscle activity is affected by the locations
of the devices as well as the tasks being performed. The results
indicate that more human-centered designs should be imple-
mented in the design of touch screen mobile devices in order to
reduce the risks of neck pain.

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