Abstract Smartphone use has become ubiquitous in modern society, with global users exceeding 6.8 billion individuals. Sustained Forward Head Posture (FHP) adopted during prolonged mobile phone engagement represents a significant public health concern, influencing musculoskeletal integrity, neuroendocrine function, and Autonomic Nervous System (ANS) homeostasis. This narrative review synthesizes contemporary evidence examining the biomechanical consequences of "text neck," upper crossed syndrome development, cervical spine load distribution, and scapular dyskinesis associated with smart phone related postural dysfunction. Secondary outcomes include cortisol dysregulation, sympathetic nervous system activation, reduced Heart Rate Variability (HRV), and respiratory compromise. A comprehensive physiotherapy perspective integrating postural correction protocols, ergonomic education, therapeutic exercise prescription, and breathing retraining strategies is presented. Current evidence demonstrates that sustained FHP increases cervical spine compressive load by 10-60 kg-force per degree of forward flexion, facilitates upper crossed syndrome manifestation through predictable muscle recruitment patterns, and compromises deep cervical flexor stabilization. Autonomic investigations reveal HRV reduction (RMSSD2.5), elevated diurnal cortisol, and decreased parasympathetic tone in chronic smartphone users. Physiotherapy interventions incorporating cervical stabilization exercises, postural re-education, ergonomic modification, and diaphragmatic breathing demonstrate significant efficacy in reversing musculoskeletal dysfunction (Cohen's d=1.21.8), normalizing HRV parameters (improvement 20-35%), and restoring stress hormone patterns within 8-12 weeks. Despite widespread smartphone adoption, evidence-based physiotherapy management remains underutilized. This paper recommends integrated postural surveillance, early intervention protocols, and workplace ergonomic standards to mitigate smartphone-related pathology. Clinical assessment of FHP angle, Cranio-Vertebral Angle (CVA), cervical range of motion, deep cervical flexor endurance, and autonomic markers should become routine physiotherapy screening measures. Future research priorities include longitudinal studies examining dose-response relationships between smartphone exposure duration and pathophysiological outcomes, comparative effectiveness trials of multimodal physiotherapy interventions, and investigation of predictive risk factors for chronic disability development. The convergence of musculoskeletal, hormonal, and autonomic dysfunction in smartphone users necessitates a biopsychosocial physiotherapy approach addressing mechanical restoration, stress regulation, and lifestyle modification simultaneously.
Muthukrishnan et al. (2026) studied this question.