Association Between Forward Head Posture, Perceived Stress, and Neck Disability in University Students: A Cross-Sectional Study

Abstract

Background: Forward head posture (FHP) is increasingly prevalent among university students due to prolonged device use, sedentary study routines, and suboptimal ergonomics, and may contribute to neck pain and functional limitation while interacting with psychosocial stress. Objective: To determine the association between forward head posture, perceived stress, and neck disability among university students. Methods: A cross-sectional study was conducted among 267 University of Lahore students (18–25 years) with self-reported neck pain and ≥3 hours/day of study-related laptop or smartphone use. FHP was assessed using the craniovertebral angle (CVA) and categorized as present/absent, neck disability was measured using the Neck Disability Index (NDI), and perceived stress was assessed using the Perceived Stress Scale (PSS-10). Associations between categorical variables were tested using chi-square analyses with effect sizes and odds ratios. Results: Mean age was 21.53 ± 2.25 years and mean CVA was 48.25° ± 3.24°. FHP prevalence was 58.8% (157/267). At least mild neck disability was reported by 89.5% (239/267), including severe disability in 30.3% (81/267). Moderate-to-high stress was present in 72.3% (193/267). FHP was not significantly associated with stress level (χ²(2)=2.411, p=0.300; Cramér’s V=0.095) or disability category (χ²(3)=2.837, p=0.417; Cramér’s V=0.103). Conclusion: FHP, perceived stress, and neck disability were highly prevalent, but categorical associations between FHP and stress or disability were weak and non-significant in this dataset, supporting the need for multifactorial, exposure-sensitive analyses and integrated prevention strategies