Analysis of the association between forward head posture, sex, and height in university students

Abstract

Anterior head translation (AHT) is a quantitative measure of the anterior displacement of the head relative to the trunk and is commonly used to assess forward head posture (FHP). Although FHP has been associated with neck pain and cervical musculoskeletal dysfunction, evidence regarding these relationships remains inconsistent across populations. This study investigated the associations among AHT/FHP, cervical sagittal alignment, sex, and height in university students. This cross-sectional screening study included 300 randomly selected students (150 females and 150 males) from Islamic Azad University, Mashhad, Iran. All 300 participants underwent photographic postural screening using Posture Pro V software. To minimise unnecessary radiation exposure, only 28 participants underwent radiographic assessment: the 14 participants with the lowest and the 14 participants with the highest PPV-derived forward head posture values. Radiographic AHT, C2–C7 cervical lordosis, and C1–C2 upper cervical angle were assessed using lateral cervical radiographs. Normality testing, independent-samples t-tests, Hedges’ g, 95% confidence intervals (CIs), and Pearson correlation coefficients were used for analysis. Compared with the minimal-FHP group, the high-FHP group showed lower C2–C7 lordosis (23.44 ± 6.26° vs. 38.29 ± 5.24°; mean difference = − 14.85°, 95% CI − 19.34 to − 10.36; p < 0.001; Hedges’ g = 2.50, large) and greater radiographic AHT (27.93 ± 11.39 mm vs. 10.07 ± 8.12 mm; mean difference = 17.86 mm, 95% CI 10.14–25.58; p = 0.001; Hedges’ g = 1.75, large). AHT was negatively correlated with C2–C7 lordosis (r = − 0.607, p = 0.001). In this selected university-student sample, higher AHT was associated with reduced C2–C7 cervical lordosis, whereas C1–C2 upper cervical curvature did not differ significantly between groups. Exploratory associations with sex and height should be interpreted cautiously because of the small extreme-groups radiographic sample and potential selection bias.