Neuro-physiological Effects of Forward Head Posture on Cervical Proprioception and Muscle Activation in University Students

Amira Ezzat Mohamed Abd ElHay ¹, Mohamed S. Zidan ², Samar Hosni Abdul Latif Hussen Amer ³, Ahmed Mohamed Ahmed Mostafa ⁴, Essraa Amin Abd El-Hamid ⁵, Sarah Sami Abdelaziz ⁶, Hadil Onsy ⁷, Engi E. Sarhan ^8,9, Marwa Yehia Abdelhamid Abdelkhalek ^10,11

¹Department of Physical Therapy, Faculty of Applied Medical Science, Al al-BAYT University, Jordan.
Email: dr.amira.ezzat.pt@gmail.com
ORCID: 0009-0001-5000-5729

²Department of Physical Therapy, Faculty of Applied Medical Science, Al-Zaytoonah University of Jordan, Amman, Jordan.
Email: drmohzidan2015@gmail.com
ORCID: 0009-0004-8464-4547

³Lecturer of Physical Therapy, Basic Sciences and Biomechanics Department, Faculty of Physical Therapy, Suez Canal University, Egypt.
Email: samar.hosny@pt.suez.edu.eg
ORCID: 0009-0000-2125-9458

⁴Department of Physical Therapy for Pediatrics and its Surgery, Faculty of Physical Therapy, Merit University, Egypt.
Email: ahmedmostafaphd2017@gmail.com
ORCID: 0000-0003-1879-7153

⁵Lecturer, Department of Physical Therapy for Woman's Health, Faculty of Physical Therapy, Al Hayah University in Cairo (AHUC), Egypt.
Email: essraa.hl@gmail.com
ORCID: 0000-0002-5211-6019

⁶Department of Physical Therapy for Surgery, School of Health Sciences, Physiotherapy Program, Queen Margaret University (UK), hosted by Capital University Foundation, Cairo, Egypt.
Email: Sarahsamimhm@gmail.com
ORCID: 0000-0003-4555-8406

⁷Orthopedic Lecturer, Faculty of Physical Therapy, Kafrelsheikh University, Egypt.
Email: hadeel_salama@pt.kfs.edu.eg
ORCID: 0009-0008-1582-8982

⁸Department of Physical Therapy for Neurology and its Surgery, Faculty of Physical Therapy, Kafrelsheikh University, Egypt.
Email: engy_elsayed@pt.kfs.edu.eg
⁹Department of Physical Therapy, College of Applied Medical Sciences, Qassim University, Buraidah 51452, Saudi Arabia.
Email: en.sarhan@qu.edu.sa
ORCID: 0009-0001-8019-3775

¹⁰Lecturer of Physical Therapy, Department of Basic Sciences, Faculty of Physical Therapy, Egyptian Chinese University, Cairo, Egypt.
¹¹Physical Therapy Department, National Heart Institute, Giza, Egypt.
Email: Marwayahia06@gmail.com; Myehia@ecu.edu.eg
ORCID: 0009-0007-0061-7755

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ABSTRACT

Background: Forward head posture (FHP) is a musculoskeletal status that has obtained increasing attention among youth, especially students enrolled in academic programs that require sitting for long periods and intensive use of digital devices.

Objective: The goal of this work is to also explore the relationship between FHP and several postural abnormalities including general postural deviation, head tilt, shoulder asymmetry, pelvic tilt, knee asymmetry and foot asymmetry in university students.

Methods: One hundred students participants have FHP symptoms were assessed using the AI Posture Evaluation and Correction System (APECS) to evaluate postural alignment deviations and the FHP app to measure the forward head angle (FHA). Pearson correlation coefficients, multiple regression analysis and factor analysis used to determine the main factors and interrelation.

Results: Strong correlations were observed between FHA and the body alignment deviations (R²=79.2%), head tilt (R²=77.4%) and also shoulder alignment deviation (R²=75.7%), suggesting that these variables play a key role in overall postural integrity. Pelvic tilt (R²=67.2%), knee asymmetry (R²=36.0%) and feet asymmetry (R²=32.5%) also showed moderate associations. Factor analysis further indicated that body alignment deviation was the strongest predictor of FHA, followed by head tilt and shoulder alignment deviation.

Conclusion: FHA plays an important role in maintaining postural integrity and significantly influences postural alignment deviations. It is also associated with pelvic tilt, knee asymmetry and foot asymmetry, reflecting its impact across the kinetic chain. Body alignment emerged as the strongest predictor of FHA, suggesting that assessing FHA is essential for preventing potential musculoskeletal complications.

Keywords: Forward Head Posture, Postural Alignment, APECS Application, Forward Head Angle (FHA), Mobile Postural Assessment.

How to cite this article: Abd ElHay AEM, Zidan MS, Amer SHALH, Mostafa AMA, Abd El-Hamid EA, Abdelaziz SS, Onsy H, Sarhan EE, Abdelkhalek MYA. Neuro-physiological effects of forward head posture on cervical proprioception and muscle activation in university students. Int J Drug Deliv Technol. 2026;16(7s): 351-359; DOI: 10.25258/ijddt.16.7s.37

Source of support: Nil.

Conflict of interest: None