The study was designed as an analytical cross-sectional survey, a snapshot approach that captures a population at a single point in time. Researchers from Bacha Khan Medical College in Mardan, Ayub Medical College in Abbottabad, and COMSATS University in Islamabad recruited medical and dental undergraduates across Khyber Pakhtunkhwa and administered a structured questionnaire combining demographic questions with three validated instruments. The Smartphone Addiction Scale-Short Version, known as SAS-SV, was used to classify participants into low and high addiction risk categories. Upper extremity disability was measured with the QuickDASH questionnaire, an abbreviated version of the Disabilities of the Arm, Shoulder and Hand tool widely used in orthopedic research. Pain intensity was recorded using the Verbal Rating Scale, or VRS. All data were analyzed in SPSS version 27.0.

The numbers that emerged were striking. High addiction risk users reported significantly higher daily use, higher SAS-SV scores, and higher QuickDASH scores, with all three comparisons reaching a statistical significance level of p less than .001. In practical terms, students flagged as high risk were not merely using their phones more; they were also reporting substantially more difficulty performing tasks with their arms, shoulders, and hands, from lifting objects to managing fine motor activities. The QuickDASH instrument scores functional limitation across a range of everyday activities, so elevated scores among heavy users suggest that phone-related strain is beginning to interfere with real-world function, not just producing occasional aches.

When the researchers examined pain by body region, the pattern sharpened. Musculoskeletal pain was more frequent among high risk users overall, and the differences were statistically significant for two specific sites: the shoulder, with a p value of .042, and the wrist and hand, with a p value of .043. These are precisely the anatomical regions that biomechanical models of smartphone use would predict. Holding a phone for extended periods requires sustained contraction of the trapezius and shoulder stabilizers, often with the arm elevated and the neck flexed forward. Meanwhile, the thumb and wrist endure repetitive flexion and extension as users scroll and type, loading tendons and joints in ways that mirror the mechanisms behind tendinopathy and repetitive strain injuries long documented in keyboard workers.

To untangle which factors independently predicted pain, the team turned to logistic regression, a statistical technique that estimates the odds of an outcome while controlling for other variables. Among high addiction risk users, age, gender, daily hours of use, perceived impact of the phone on daily life, and SAS-SV scores were all significantly associated with pain in multiple body regions. In the low risk group, the picture was narrower: only SAS-V scores and pain at selected sites, specifically the lower back and wrist, showed significant associations. This asymmetry suggests that once smartphone use reaches the high risk range, its physical consequences spread across the body, whereas in moderate users the effects remain more localized and closely tied to the addiction score itself.

Disability, as measured by QuickDASH, followed its own distinct pattern. In low risk users, disability scores were significantly associated with SAS-SV scores and elbow pain. In high risk users, however, the significant associations shifted to female gender and the presence of pain at multiple sites. The gender finding deserves attention. Previous research on digital device ergonomics has repeatedly found that women report more musculoskeletal symptoms from device use, potentially due to differences in hand size relative to device dimensions, wrist geometry, muscle strength, and pain sensitivity. That female gender emerged as a significant correlate of disability specifically in the high risk group hints that heavy phone use may amplify pre-existing anatomical and physiological vulnerabilities.

The study’s setting gives its findings particular weight. Medical students face a double burden: the academic demands of their training, which involve long hours of reading and screen work, and the near-universal smartphone dependence of their generation. In Pakistan, as elsewhere, phones have become the primary portal for study materials, social connection, and entertainment. The researchers note that smartphone addiction has emerged as a growing public health concern among university students and is linked to poor posture and repetitive movements, habits that contribute to pain in the neck, shoulders, and upper extremities. If future physicians are accumulating musculoskeletal damage before they even begin clinical practice, the implications extend beyond individual health to the resilience of the healthcare workforce itself.

The study was approved by the Institutional Review Board of Bacha Khan Medical College Mardan under reference number 796/BKMC, and written informed consent was obtained from all participants before enrollment. The authors declare no competing interests and received no financial support for the work. As an open access publication, the article is available to researchers, clinicians, and educators worldwide, and its early-release status means the citable version of record will follow with further edits.

Cross-sectional designs have inherent limits, and the authors’ own framing is careful. Because exposure and outcome are measured simultaneously, such studies can establish association but not definitive causation; it remains possible that students in pain turn to their phones more, or that shared underlying factors drive both. Self-reported scales also depend on honest and accurate recall. Nevertheless, the consistency of the findings with prior work, including earlier cross-sectional studies linking smartphone overuse to neck and wrist pain in medical and nursing undergraduates and to pain among college students more broadly, strengthens the case that the relationship is real and clinically meaningful.

The authors’ conclusion points toward prevention rather than alarm. High addiction risk users among medical students, they write, are significantly associated with musculoskeletal pain and upper extremity disability, especially in the shoulders and wrists, and preventive strategies such as ergonomic education, early screening, and awareness are essential to reduce these health risks. In practice, that could mean teaching students neutral wrist positioning and regular micro-breaks, integrating posture awareness into medical curricula, and using brief screening tools like the SAS-SV to identify heavy users before pain becomes chronic. For a generation whose hands rarely leave their screens, the study is a reminder that the most common medical instrument many future doctors will ever hold is the one already in their palm, and that it, too, deserves to be used with care.

Subject of Research: Smartphone addiction risk and its association with musculoskeletal pain and upper extremity disability among medical students

Article Title: Musculoskeletal pain and upper extremity disability in relation to smartphone addiction risk among medical students of Khyber Pakhtunkhwa

Article References: Maaz, M., Ullah, M., Tahir, M., Amir, S., Khan, M. H., & Ahmad, M. (2026). Musculoskeletal pain and upper extremity disability in relation to smartphone addiction risk among medical students of Khyber Pakhtunkhwa. Discover Social Science and Health, 6(1), Article 112. https://doi.org/10.1007/s44155-026-00450-2

Image Credits: AI Generated

DOI: 10.1007/s44155-026-00450-2

Keywords: smartphone addiction, musculoskeletal pain, upper extremity disability, medical students, QuickDASH, SAS-SV, shoulder pain, wrist pain, ergonomics, cross-sectional study, Pakistan, public health