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This examine investigated the rapid results of three sitting positions, together with chair sitting with and with out a backrest and cross-legged sitting on the ground, on cervical and trunk postures, musculoskeletal discomfort, and ergonomic danger throughout smartphone gaming amongst younger adults.
A randomized within-subject examine was performed in 41 wholesome members (imply age 20.4 ± 1.1 years). Each participant performed Realm of Valor (ROV) on their private smartphone for 20 minutes in three randomly assigned sitting positions. Cervical and trunk angles had been measured utilizing two-dimensional photogrammetry at baseline and at 5, 10, 15, and 20 minutes. Ergonomic danger was assessed utilizing the Rapid Upper Limb Assessment (RULA), with the utmost rating used for evaluation. After every session, members reported perceived musculoskeletal discomfort utilizing a visible analog scale.
A big interplay between time and sitting place was discovered for each neck flexion (F(3.87, 232.27) = 5.31, p < 0.001, partial η² = 0.081) and trunk angles (F(8,480) = 2.73, p = 0.006, partial η² = 0.044). Perceived neck discomfort was the commonest symptom, with the cross-legged place displaying the best prevalence (51.2%, Cochran’s Q = 8.67, p = 0.013, Kendall’s W = 0.106). However, symptom depth didn’t differ considerably amongst positions. RULA scores additionally differed throughout sitting positions (χ²(2) = 27.0, p < 0.001, Kendall’s W = 0.329), with the cross-legged place displaying the best rating.
Sitting posture considerably affected cervical and trunk alignment, perceived discomfort, and ergonomic danger throughout smartphone gaming. Cross-legged sitting induced the best neck and trunk flexion, which can contribute to elevated musculoskeletal pressure over time. These findings emphasize the significance of selling ergonomic consciousness and wholesome digital habits to take care of spinal alignment and cut back posture-related musculoskeletal pressure; nonetheless, longitudinal research are wanted to substantiate long-term results.
Citation: Nilmart P, Yodchaisarn W, Vajidee N, Tansakul N, Sramongkhol W, Leangsakul S (2026) Immediate results of sitting place on cervical and trunk posture, perceived discomfort, and RULA-based ergonomic danger throughout smartphone gaming: A randomized within-subject examine. PLoS One 21(7):
e0354360.
https://doi.org/10.1371/journal.pone.0354360
Editor: Mshari Alghadier, Prince Sattam bin Abdulaziz University, SAUDI ARABIA
Received: January 15, 2026; Accepted: July 7, 2026; Published: July 21, 2026
Copyright: © 2026 Nilmart et al. This is an open entry article distributed underneath the phrases of the Creative Commons Attribution License, which allows unrestricted use, distribution, and replica in any medium, offered the unique creator and supply are credited.
Data Availability: The knowledge underlying the outcomes of this examine aren’t publicly accessible resulting from moral restrictions, as they comprise doubtlessly delicate data from human members. Data can be found upon cheap request from the Human Research Ethics Committee at Walailak University (contact: wu.wuec@gmail.com) for researchers who meet the factors for entry to confidential knowledge.
Funding: The creator(s) obtained no particular funding for this work.
Competing pursuits: The authors have declared that no competing pursuits exist.
Smartphone use has develop into an integral a part of day by day life for communication, work, schooling, and leisure, together with aggressive on-line gaming [1]. In latest years, smartphone possession and day by day display screen time have elevated considerably, contributing to extra sedentary behaviors and even smartphone dependancy [2]. These behaviors are sometimes related to flexed‑neck postures generally described as “text neck,” characterised by extended cervical flexion whereas viewing the smartphone display screen [3, 4]. The recognition of cellular gaming additional amplifies these dangers, as prolonged gameplay periods might reinforce poor postural habits and contribute musculoskeletal discomfort, representing a rising public well being concern.
Sitting posture performs an vital position in sustaining spinal alignment and figuring out the diploma of biomechanical loading throughout smartphone use. Deviations in cervical and trunk posture can enhance muscle exercise and mechanical pressure, contributing to musculoskeletal problems. A earlier examine confirmed that extended smartphone use induces vital adjustments in neck and trunk flexion in contrast with different seated actions [5]. Among smartphone players and eSports athletes, lengthy intervals of static sitting additional enhance the mechanical load on the cervical and thoracic backbone, growing the chance of growing musculoskeletal issues [6]. Prolonged cervical flexion throughout smartphone duties has been linked to elevated neck muscle exercise and discomfort [7, 8]. Moreover, elevated neck, higher again, and shoulder ache have been related to static postures and sustained muscle rigidity in handheld gadget customers might have opposed results on productiveness and high quality of life [9].
Ergonomic danger evaluation instruments present an goal framework to evaluate postural danger throughout smartphone use. The Rapid Upper Limb Assessment (RULA) has been broadly utilized to judge neck, trunk, and higher‑limb postures and to estimate the chance of labor‑associated musculoskeletal problems [10]. A earlier examine demonstrated a excessive ergonomic danger amongst smartphone customers, as indicated by RULA outcomes [11]. Variations in sitting posture, equivalent to supported versus unsupported sitting or completely different leg positions, due to this fact have the potential to change each spinal kinematics and RULA‑derived danger ranges throughout smartphone duties [12]. However, most present analysis has centered on chair sitting and basic smartphone duties equivalent to texting, searching, and video watching, with comparatively few research inspecting culturally particular ground‑sitting postures throughout smartphone use or gaming [13]. Cultural sitting behaviors, equivalent to cross-legged sitting on the ground, which is especially widespread in Thai and different Asian populations, might additional alter trunk and cervical mechanics and current completely different ergonomic dangers in contrast with conventional chair-based postures. These variations in culturally influenced sitting positions warrant additional investigation to know higher their affect on posture and musculoskeletal well being throughout smartphone gaming.
Therefore, this examine aimed to analyze the consequences of three sitting positions, together with sitting on a chair with and with out a backrest, and cross-legged sitting on the ground, on cervical and trunk postures, musculoskeletal discomfort, and ergonomic danger throughout smartphone gaming in younger adults. We hypothesize that sitting with out again help or in a cross-legged posture would lead to larger neck flexion, altered trunk alignment, elevated musculoskeletal discomfort, and the next ergonomic danger in contrast with sitting with backrest help. The findings from this examine might contribute to evidence-based ergonomic suggestions and bodily remedy interventions to scale back posture-related neck and again issues amongst recurring smartphone players.
This examine employed a laboratory-based within-subject repeated-measures experimental design with randomized sequence of sitting positions. Each participant carried out smartphone gaming in three completely different sitting situations for 20 minutes per situation. Participant recruitment and knowledge assortment had been performed between January and July 2021 within the Physical Therapy Laboratory at Walailak University, Thailand, the place temperature, lighting, and seating situations had been standardized to reduce environmental variability. The examine protocol and consent procedures had been reviewed and permitted by the Human Research Ethics Committee at Walailak University, Thailand (Reference No. WUEC-20-222-01). All members offered written knowledgeable consent previous to participation. All experimental procedures had been performed in accordance with the Declaration of Helsinki. This examine was reported in accordance with the STROBE pointers, the place relevant. Participant movement is offered in Fig 1.
Eligible members had been males or females aged 18–24 years who had been enjoying Realm of Valor (ROV) on a smartphone for not less than 20 minutes per day, three days per week, for not less than six months. Participants had been excluded in the event that they (1) had any musculoskeletal or neurological problems, together with the presence of any present ache at relaxation, a historical past of spinal deformity, structural abnormalities of the backbone or extremities, or any recognized situations affecting these areas; (2) had acute accidents or localized signs equivalent to chest ache, open wounds, sharp ache, swelling, or sprains; or (3) offered with basic well being issues that might intervene with participation, equivalent to fatigue, palpitations, dizziness, syncope, or uncorrected visible impairment. Participants had been withdrawn from the examine in the event that they voluntarily discontinued participation earlier than finishing the protocol.
An a priori energy evaluation was performed utilizing G*Power software program (model 3.1.9.7, Germany) to find out the required pattern dimension. The calculation was primarily based on an F-test (ANOVA: repeated measures, inside components). A medium impact dimension of 0.25 was set, with a statistical energy of 0.90 and an alpha stage of 0.05. The variety of measurements was set at 5, with an assumed correlation amongst repeated measures of 0.3 and a nonsphericity correction (ε) of 1.0. The evaluation indicated {that a} whole of 36 members had been required. To account for an anticipated 15% dropout charge resulting from incomplete knowledge, the ultimate pattern dimension was elevated to 41 members.
The outcomes had been cervical and trunk postures (neck flexion angle and trunk angle), musculoskeletal discomfort, and ergonomic danger. All assessors underwent standardized coaching in accordance with the examine protocol earlier than knowledge assortment to make sure procedural consistency and measurement accuracy. The assessor chargeable for cervical and trunk posture measurements was a senior bodily therapist with over 20 years of scientific expertise in musculoskeletal apply. Two extra assessors, who collected knowledge on perceived musculoskeletal discomfort and ergonomic danger, had been novice bodily therapists with one 12 months of related scientific expertise; each obtained particular coaching to make sure correct and constant knowledge assortment.
The neck flexion and trunk angles had been used to characterize cervical and trunk postures, respectively. Anatomical markers had been positioned on particular landmarks, together with the tragus, the spinous processes of C7 and T12, and the larger trochanter, following palpation by the identical skilled assessor. Participants wore fitted clothes, and openings had been created at marker places to permit direct placement on the pores and skin, guaranteeing correct identification of anatomical landmarks and avoiding marker placement over clothes. The neck flexion angle was outlined because the angle shaped between a line connecting the tragus and the spinous strategy of C7 and a vertical reference line (measured anterior to the intersection). The trunk angle was outlined because the angle shaped between the road connecting C7 to T12 and one other connecting T12 to the larger trochanter, measured posterior to the intersection [14] (Fig 2). Digital video recordings had been obtained within the sagittal aircraft utilizing a high-definition digital camera (PAL, 25 frames per second, decision 720 × 576 pixels; Sony HDR-PJ670, Tokyo, Japan) positioned three meters from the participant. The digital camera top was individually adjusted for every participant to align with the acromion course of. The assessor measured and adjusted the digital camera in order that the middle of the lens was positioned on the stage of the acromion course of for every sitting situation. Prior to every recording, digital camera alignment was calibrated utilizing a spirit stage to make sure that the digital camera axis was parallel to the bottom. Joint angle measurements had been obtained from video recordings at predefined time factors (0, 5, 10, 15, and 20 minutes) throughout every session. All angular measurements had been analyzed utilizing Kinovea™ software program (model 2023.1.1), which permits two-dimensional movement evaluation by way of frame-by-frame photographic evaluation [15]. Prior to knowledge assortment, intra- and inter-rater reliability for photographic angle measurements had been assessed. Two skilled assessors independently measured every angle at every time level, with every measurement repeated thrice. Intraclass correlation coefficients (ICC) had been calculated utilizing a two-way mixed-effects mannequin with absolute settlement, demonstrating wonderful reliability (ICC vary = 0.86–0.99; corresponding 95% confidence intervals ranged from 0.444 to 0.998).
Musculoskeletal discomfort that occurred in the course of the 20-minute gaming session was reported instantly after gameplay. Participants recognized the placement(s) utilizing a standardized physique chart, and symptom depth was rated utilizing a Visual Analog Scale (VAS) starting from 0 (“no pain”) to 10 (“worst imaginable pain”) [16]. The highest depth rating reported for every location was used for evaluation.
Ergonomic danger was evaluated utilizing the Rapid Upper Limb Assessment (RULA), which has been used to evaluate ergonomic dangers in smartphone customers [11, 17]. RULA confirmed the strongest affiliation with musculoskeletal dysfunction (MSD) ranges and is due to this fact thought-about notably appropriate for assessing MSD danger within the higher limbs and the neck–trunk area [18]. RULA evaluation was performed constantly all through every 20-minute session primarily based on skilled assessor remark. For evaluation, the best RULA rating noticed throughout gameplay was used to characterize the utmost RULA-derived ergonomic danger for every sitting place, capturing probably the most opposed posture maintained throughout gameplay.
All enrolled members offered demographic and smartphone-related data, together with age, intercourse, physique weight, top, hand dominance, years of smartphone use, gadget weight (together with protecting case), display screen dimension, and smartphone gaming habits. All experimental periods had been performed in the identical laboratory room underneath managed environmental situations (temperature 25–26°C, satisfactory lighting, and minimal background noise).
The order of the three sitting positions, specifically chair with backrest, chair with out backrest, and cross-legged sitting on the ground, was randomly assigned to every participant utilizing a lottery draw methodology with six predefined orders to reduce sequence results and to assist distribute situation orders throughout members. The allocation sequence was hid till task to stop choice bias. A standardized armless chair with an open backrest design was used for all members. The chair had a seat top of 47 cm, a backrest top of 41 cm (measured from the seat floor), a backrest inclination of roughly 10°, and a seat diameter of 37 cm. The no-backrest situation used a chair of the identical dimensions with out a backrest. If a participant’s ft didn’t attain the ground, a footrest was offered to take care of roughly 90 levels of hip and knee flexion and a impartial pelvic alignment. For cross-legged sitting, members sat on a agency yoga mat with out extra cushioning. The completely different sitting positions used on this examine are illustrated in S1 Fig. Each trial started after the participant assumed the goal sitting place for not less than one minute to make sure postural stabilization earlier than recording commenced.
For every sitting situation, members performed ROV on their very own smartphones to make sure pure dealing with and familiarity with the gadget. Gameplay was carried out at every participant’s traditional talent stage, as all members had been skilled gamers. Each gaming session lasted 20 minutes, throughout which members had been instructed to take care of their posture naturally with out verbal correction or interference. After finishing every session, a relaxation interval of roughly 10 minutes, or till any fatigue, muscle tightness, ache, or discomfort had resolved, was offered earlier than continuing to the subsequent randomized posture, guaranteeing that no residual signs together with fatigue, muscle tightness, ache, or discomfort had been current previous to the following situation.
During gameplay, RULA scoring was carried out by a skilled assessor positioned laterally to the participant, aligned with the digital camera location. The assessor was seated on an elevated chair to make sure a transparent view of the participant’s posture and all related actions required for RULA analysis. The assessor maintained a constant remark place all through the session however allowed restricted, managed actions inside a predefined space, equivalent to briefly standing or leaning ahead, to enhance visibility, when vital, with out interfering with the participant’s visible discipline or focus. Standardized scoring procedures had been adopted to reduce potential bias. After every 20-minute session, one other assessor instantly recorded the participant-reported discomfort utilizing a standardized physique chart and assessed depth utilizing a VAS.
All statistical analyses had been carried out utilizing SPSS for Windows model 23 (IBM Corp., Armonk, NY, USA). A p-value < 0.05 was thought-about statistically vital. Descriptive statistics had been used to summarize members’ demographic traits, gaming habits, and smartphone utilization. Continuous variables (neck flexion angle, trunk angle, symptom depth, and RULA rating) had been handled as quantitative knowledge and are offered as imply ± commonplace deviation (SD), whereas categorical variables are offered as frequencies and percentages. All statistical assumptions had been verified previous to evaluation, together with normality (Shapiro–Wilk take a look at). Whereas assumptions weren’t met, applicable non-parametric exams had been utilized. No lacking knowledge was noticed for any key variables.
The results of sitting place (backrest, no-backrest, cross-legged) and time (5 time factors: T0–T4) on neck flexion angle and trunk angle had been analyzed utilizing a two-way repeated-measures ANOVA (3 × 5 design). The assumption of sphericity for repeated measures was assessed utilizing Mauchly’s take a look at. When the idea was violated, Greenhouse–Geisser corrections had been utilized to regulate the levels of freedom. When sphericity was met, outcomes primarily based on sphericity-assumed estimates had been reported. When vital most important or interplay results had been noticed, Bonferroni-adjusted post-hoc pairwise comparisons had been performed. Effect sizes for the ANOVA analyses had been reported as partial eta squared (η²).
Because perceived musculoskeletal discomfort depth and ergonomic danger scores (RULA) didn’t meet the assumptions of normality, these variables had been in contrast throughout sitting positions utilizing the Friedman take a look at for associated samples. Post-hoc pairwise comparisons had been performed utilizing Wilcoxon signed-rank exams with Bonferroni correction when the Friedman take a look at indicated a major impact. Differences within the frequency of symptom places amongst sitting positions had been examined utilizing Cochran’s Q take a look at. Kendall’s W was used to estimate impact sizes for non-parametric exams, together with the Friedman take a look at and Cochran’s Q take a look at.
A complete of 48 members had been assessed for eligibility. Of these, 7 members met exclusion standards. A complete of 41 members had been enrolled on this examine. Most members had been younger grownup males (85.4%) with regular physique mass index and intensive expertise in smartphone gaming. On common, they reported a number of years of smartphone use and frequent gameplay periods. Most members had been right-hand dominant. Detailed demographic and smartphone-related traits are summarized in Table 1.
A two-way repeated measures ANOVA demonstrated a major interplay impact between sitting place and time for neck flexion angle (Greenhouse–Geisser corrected: F(3.87, 232.27) = 5.31, p < 0.001, partial η² = 0.081), indicating that the magnitude and development of cervical postural adjustments differed amongst sitting positions over time. Significant most important results had been additionally discovered for sitting place (F(2,120) = 26.88, p < 0.001, partial η² = 0.309) and time (Greenhouse–Geisser corrected: F(1.94, 232.27) = 189.25, p < 0.001, partial η² = 0.612), suggesting temporal variations in cervical posture throughout smartphone gameplay. Post-hoc pairwise comparisons (Bonferroni-adjusted) confirmed that the cross-legged place demonstrated the best neck flexion, adopted by no-backrest, whereas the backrest place confirmed the smallest angles. These variations had been persistently noticed at every time level from T1 to T4, with considerably larger neck flexion within the cross-legged place in contrast with each backrest and no-backrest situations (p ≤ 0.001). Detailed pairwise comparisons for every time level are offered in S1 Table. Spaghetti plots of neck flexion for all three sitting situations are offered in S2–S4 Figs.
For trunk posture, a major interplay impact between sitting place and time was noticed (F(8,480) = 2.73, p = 0.006, partial η² = 0.044). The most important impact of sitting place was not vital (F(2,120) = 1.50, p = 0.226, partial η² = 0.024), whereas a major most important impact of time was discovered (F(4,480) = 43.39, p < 0.001, partial η² = 0.266). Post-hoc pairwise comparisons revealed that at baseline (T0), members within the backrest place exhibited smaller trunk angles than these within the cross-legged place (p = 0.043), reflecting a extra upright or barely reclined trunk alignment, whereas no vital variations had been noticed at later time factors (S2 Table). Overall, members sitting cross-legged or with out again help tended to take care of larger ahead trunk inclination all through gameplay. Spaghetti plots of trunk angle for all three sitting situations are offered in S5–S7 Figs. The outcomes are summarized in Table 2, and the temporal patterns of cervical and trunk postures are illustrated in Figs 3 and 4.
All members reported a point of perceived musculoskeletal discomfort within the axial area (neck, shoulder girdle, higher again, and decrease again) throughout smartphone gaming, regardless of the absence of resting ache at baseline. As proven in Table 3, probably the most incessantly reported location was the neck, notably in the course of the cross-legged sitting situation, the place roughly half of the members (51.2%) skilled neck discomfort. The incidence of neck discomfort differed considerably amongst sitting positions (p = 0.013, Kendall’s W = 0.106), whereas no vital variations had been discovered for the shoulder girdle, higher again, or decrease again areas (p > 0.05). In addition, the proportion of members reporting perceived discomfort with an depth of VAS ≥ 2 was examined to assist scientific interpretation, displaying an identical sample, with the neck remaining probably the most incessantly affected area, notably within the cross-legged sitting situation, whereas different areas confirmed comparable patterns throughout sitting positions. As offered in Table 4, symptom depth scores didn’t considerably differ amongst sitting positions for any area (p > 0.05).
Most members demonstrated average ergonomic danger (Level 2) primarily based on RULA evaluation, as proven in Fig 5. The Friedman take a look at revealed vital variations in each RULA scores (χ²(2) = 27.0, p < 0.001, Kendall’s W = 0.329) and RULA-based danger ranges (χ²(2) = 24.88, p < 0.001, Kendall’s W = 0.303) amongst sitting positions. Post-hoc evaluation indicated that the cross-legged sitting place had considerably greater RULA scores, and RULA-based danger ranges in contrast with each backrest and no-backrest positions (p < 0.001). Overall, the cross-legged place was related to the best ergonomic danger, adopted by no-backrest and backrest positions (Table 5).
These findings confirmed a major interplay between sitting place and gameplay time on each cervical and trunk postures. Sitting on a chair, both with or with out a backrest, and sitting cross-legged on the ground affected posture in distinct methods. Moreover, neck discomfort and RULA-derived ergonomic danger diversified considerably throughout positions, highlighting the direct position of posture in musculoskeletal outcomes.
Cervical and trunk postures modified step by step all through the 20-minute gaming session in contrast with baseline. The vital interplay with time displays a postural drift phenomenon, the place gradual flexion develops throughout extended sitting. In addition, aggressive cellular gaming, equivalent to ROV, locations excessive cognitive calls for by way of sustained consideration and fast decision-making. Increased cognitive load has been linked to elevated gamma exercise and will affect postural regulation mechanisms [19]. These findings are in keeping with earlier research reporting elevated cervical flexion throughout smartphone video viewing [20]. Similarly, unsupported sitting has been proven to provide larger neck flexion angles than supported sitting throughout smartphone use [21]. In the current examine, the cross-legged sitting posture induced the best neck flexion, adopted by sitting with out a backrest, whereas the backrest place resulted within the smallest cervical angles. This sample aligns with earlier proof displaying poor neck posture in floor-sitting positions throughout smartphone use [22]. Excessive neck flexion will increase activation of the higher trapezius and sternocleidomastoid muscle mass, contributing to cumulative pressure over extended use [23]. Regarding trunk posture, the backrest place promoted a extra impartial or barely reclined alignment, notably firstly of gameplay. However, as gaming continued, all positions demonstrated a gradual enhance in trunk flexion after 5 minutes and remained comparatively fixed till the tip of the session. Prolonged visible consideration to smartphone screens, equivalent to texting or watching movies, has been related to elevated trunk inclination and thoracic kyphosis in contrast with impartial posture [24]. However, completely different postural methods for the neck and trunk throughout smartphone use can also rely on environmental components, equivalent to forearm help on a desk [25].
Perceived neck discomfort was probably the most incessantly reported symptom throughout smartphone gaming, particularly within the cross-legged sitting place. This discovering is in keeping with proof that extended neck flexion and static sitting enhance deviation of the pinnacle and neck angle and mechanical pressure on cervical buildings, together with the trapezius muscle mass, leading to discomfort [26, 27]. However, symptom depth didn’t considerably differ throughout sitting positions, probably as a result of comparatively brief publicity interval. The 20-minute period might not have been lengthy sufficient to induce noticeable ache responses in contrast with recurring extended gaming over a number of hours [28]. A earlier examine has prompt that elevated neck ache and decreased muscle endurance are related to smartphone utilization period [29].
The RULA evaluation revealed vital variations in RULA-derived ergonomic danger throughout sitting positions, with the cross-legged posture related to the best danger. Participants on this posture had been distributed throughout RULA Levels 2 and three in almost equal proportions, indicating average to excessive ranges of RULA-based danger. These findings help a previous examine displaying that floor-sitting induces irregular postural alignment, which will increase ergonomic danger scores [22]. However, most members within the chair-sitting situations demonstrated average RULA-based danger (Level 2), in keeping with earlier analysis [30]. Another examine recognized Level 3 danger in smartphone customers, which can be defined by variations in job sort and utilization situations, as earlier research concerned texting and searching underneath pure use with out time constraints and with out standardized management of posture or help situations [11]. Moreover, a earlier examine has proven that even 10 minutes of smartphone texting can induce postures related to elevated ergonomic danger [31]. This average to excessive stage of RULA-based danger means that postural situations could also be suboptimal for sustained exercise and will profit from ergonomic modification or posture coaching to scale back musculoskeletal pressure. Consequently, interventions selling supported sitting and adjustable seating might assist enhance postural alignment and cut back perceived musculoskeletal danger throughout smartphone gaming.
From an ergonomic perspective, these findings emphasize the significance of sitting posture in influencing cervical and trunk alignment and perceived musculoskeletal discomfort throughout smartphone use. Physical therapists and ergonomists might promote posture consciousness by encouraging customers to take care of an upright trunk and keep away from sustained neck flexion to enhance postural alignment. Implementing posture-based interventions, equivalent to energetic breaks or cervical stabilization workout routines, might assist help neck perform and cut back perceived musculoskeletal pressure throughout smartphone gaming.
This examine has some limitations. Most members had been younger grownup males, which limits generalizability to females and older adults who might differ in musculoskeletal vulnerability and symptom patterns. The inclusion of cross-legged sitting, a culturally influenced posture, might restrict generalizability to populations with completely different sitting habits. The 20-minute gaming period might not absolutely characterize real-world situations the place gaming periods usually prolong past one hour. Although randomization and relaxation intervals had been applied, residual results associated to cognitive load or postural fatigue can’t be totally excluded. In addition, RULA evaluation was primarily performed from a lateral view to reduce interference with participant focus, which can have restricted the power to seize some postural deviations exterior the lateral view, and using the utmost rating might have overestimated ergonomic danger. Furthermore, permitting members to make use of their very own smartphones and play at their traditional talent stage might have launched variability in viewing distance, posture, and cognitive load. Although 2D photographic evaluation demonstrated excessive reliability and is sensible for scientific use, it could not seize postural adjustments exterior the aircraft of remark and is much less correct than 3D movement evaluation. Therefore, the findings must be interpreted with warning. Future research ought to embody extra various populations and contemplate a wider vary of sitting behaviors and utilization contexts to enhance generalizability. In addition, standardizing gadget traits or incorporating gameplay-related variables as covariates might assist cut back variability. Intervention research inspecting ergonomic aids or posture coaching applications might additional make clear methods to scale back musculoskeletal dangers throughout smartphone gaming.
Different sitting positions throughout smartphone gaming resulted in distinct cervical and trunk postures and ranging ergonomic dangers. The cross-legged posture produced larger cervical and trunk flexion, the next prevalence of neck discomfort, and a larger ergonomic danger than supported sitting. The emergence of musculoskeletal discomfort suggests the presence of early musculoskeletal issues related to sustained flexed postures. The outcomes present a foundation for growing ergonomic suggestions and focused interventions to scale back postural pressure throughout smartphone use amongst younger adults and will assist help musculoskeletal well being and well-being, though longitudinal research are wanted to substantiate long-term results.
The volunteer model provided written informed consent for publication. Facial features were obscured to maintain anonymity.
https://doi.org/10.1371/journal.pone.0354360.s003
(TIF)
Thin gray lines represent individual participants, and the solid blue line indicates the mean with 95% confidence intervals. Time points T0–T4 correspond to 0, 5, 10, 15, and 20 minutes of smartphone gaming, respectively.
https://doi.org/10.1371/journal.pone.0354360.s004
(TIF)
Thin gray lines represent individual participants, and the solid blue line indicates the mean with 95% confidence intervals. Time points T0–T4 correspond to 0, 5, 10, 15, and 20 minutes of smartphone gaming, respectively.
https://doi.org/10.1371/journal.pone.0354360.s005
(TIF)
Thin gray lines represent individual participants, and the solid blue line indicates the mean with 95% confidence intervals. Time points T0–T4 correspond to 0, 5, 10, 15, and 20 minutes of smartphone gaming, respectively.
https://doi.org/10.1371/journal.pone.0354360.s006
(TIF)
Thin gray lines represent individual participants, and the solid blue line indicates the mean with 95% confidence intervals. Time points T0–T4 correspond to 0, 5, 10, 15, and 20 minutes of smartphone gaming, respectively.
https://doi.org/10.1371/journal.pone.0354360.s007
(TIF)
Thin gray lines represent individual participants, and the solid blue line indicates the mean with 95% confidence intervals. Time points T0–T4 correspond to 0, 5, 10, 15, and 20 minutes of smartphone gaming, respectively.
https://doi.org/10.1371/journal.pone.0354360.s008
(TIF)
Thin gray lines represent individual participants, and the solid blue line indicates the mean with 95% confidence intervals. Time points T0–T4 correspond to 0, 5, 10, 15, and 20 minutes of smartphone gaming, respectively.
https://doi.org/10.1371/journal.pone.0354360.s009
(TIF)
We want to thank all members for his or her cooperation in the course of the knowledge assortment course of. We additionally acknowledge the statistical session offered in the course of the examine design and knowledge evaluation processes. In addition, we respect the help and help from all people who contributed to the profitable completion of this examine.
The authors used ChatGPT (OpenAI, GPT-5 sequence) to help with language modifying, grammatical refinement, and enchancment of manuscript readability in chosen sections of the manuscript. The AI software was not used to generate authentic scientific content material, analysis knowledge, examine outcomes, figures, or interpretations. All content material produced with AI help was critically reviewed, revised, and verified by the authors, who take full duty for the accuracy, integrity, and originality of the ultimate manuscript. AI instruments weren’t listed as authors.
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