COMPARISON OF FORWARD

HEAD POSTURE USING

SMARTPHONE AND READING
BOOKS IN UNIVERSITY
STUDENTS

Submitted by : Maria Azam (M-16339)

Zeeshan Hameed (M-16838)
Session: 2016-2021
Program: DPT
Supervisor: Sir Haroon Raza
 Introduction
• A forward head posture of the head and neck creates a state
of musculoskeletal imbalance with shortening of the
posterior cervical and suboccipital muscles, tightness of the
anterior chest muscles, lengthening and weakness of the
anterior neck flexors and supra- and infra-hyoid muscles,
weakness of the upper back and scapular retractor muscles,
increased stress on ligaments. The adjusted mechanics
related with forward head stance may prompt unreasonable
pressure on the aspect joints and back surfaces of the
vertebral bodies (1)
• While sitting, forward head position incorporates flexion of lower
cervical area, extension of upper cervical region, and rounded
shoulders, which in normal decreases the length of muscle fibers,
bringing about extensor torque around the joints of upper cervical
region. This abnormal state brings about musculoskeletal problems
which incorporates reduced scapular upward rotation, more
prominent internal rotation and anterior tilt, bringing about trouble
to keep up upstanding sitting posture. (2, 3)
• A forward head posture of the head and neck creates a state of
musculoskeletal imbalance with shortening of the posterior cervical
and suboccipital muscles, tightness of the anterior chest muscles,
lengthening and weakness of the anterior neck flexors and supra- and
infra-hyoid muscles, weakness of the upper back and scapular
retractor muscles, increased stress on ligaments.
 Article 01:
• Article 01:
Arfa Naz et. al (2020)
• A study conducted by Arfa Naz et al. in 2020. Study aimed to determine the
prevalence of forward head posture among university students and its possible
correlation with other posture related factors. This cross-sectional study was
carried out on 197 students from four different universities. A modified
questionnaire was used to collect the data and posture was assessed using a
plumb line. The data were analyzed using SPSS version 21. The prevalence of
forward head posture was found to be 63.96%, including male and female
students. The forward head posture was found to be correlated with shoulder
rolling forward. The forward head posture is very prevalent among the
university students. It is correlated shoulder rolling forward.

• Naz A, Bashir MS, Noor R. Prevalance of forward head posture among university students. Rawal Medical Journal.
2018;43(2):260-2.
 Article 02:
.
Th study by Xiaofei Guan1 • Guoxin Fan1 The photographic method showed
high intra- and inter-rater reliability in measuring cervical spine sagittal
posture and gaze angle (ICC ranged from 0.80 to 0.99). When looking at the
mobile phone, the head tilt angle increased significantly (from 74.55 to 95.22,
p = 0.000) and the neck angle decreased (from 54.68 to 38.77, p = 0.000).
Forward head posture was also confirmed by significantly greater head
displacement (10.90 to 13.85 cm, p = 0.000). The posture assumed in the use
of the mobile phone was significantly correlated with the neutral posture (p
<0.05). Males showed a more forward head posture than females (p <0.05).
Head tilt angle was positively correlated with gaze angle (r = 0.616, p = 0.000),
while neck tilt angle was negatively correlated with gaze angle (r = -0.628, p =
0.000). Compared to neutral position, subjects show more forward head
posture when viewing mobile phone screen, which correlates with neutral
posture, gaze angle, and gender. Future studies will be needed to investigate a
dose-response relationship between mobile phone use and posture.(35)
 Article 03:

The study of Sami S. AlAbdulwahab PT PhD | Shaji John Kachanathu PT PhD

The purpose of the study was to determine the level of addiction to
smartphones and its relationship with neck function on billboards in healthy
young adult subjects. The sample size was calculated with a confidence level
of 95% and an error of ± 0.5. The mean age was 21.3 ± 1.7 years, the mean
weight was 63.4 ± 15.9 kg, and the mean height was 1.66 ± 8.6 m. They
reported no history of physical or mental illness. They all used a smartphone
for several hours a day. The results of the study showed a clear association
between addiction to the use of smartphones and various degrees of neck
problems among the participants. The mean SAS and NDI scores were 119.4 ±
20.7 and 20.98 ± 5.1, respectively. Spearman's correlation coefficient showed
a significant correlation (p <0.05) between SAS and NDI scores.(41).
 Objectives
• To determine the comparison of forward head posture
among university students reading books and using
smartphone.
 Rationale
Previously a lot of studies have been conducted on the effect of Mobile
phone usage on the Forward head posture but according to the best of
our knowledge, sufficient data was not found on the consequence of
Reading books on the Forward head posture. Because reading books in
a poor posture can also affect the forward head posture. So here we
are going to conduct a research to determine that how, reading books
and using mobile phone affect the forward head posture.
 Research
Question/Hypothesis

• Comparison of Forward Head Posture in University Students using

mobile phones and reading books?

• The experimental study should use a hypothesis but observational

study usually not contain hypothesis. The hypothesis is an assumed
relationship between an independent and dependent variable.
 Methodology
• Study design:
• Design of study was Cross-Sectional.

• Study Settings:
• Data was collected from the students in University of South Asia those who was
easily available and agree to deliver the information that is correct and sufficient.
 Variables of Study

• Forward head Posture was a Dependent Variable while Reading Books

and Using Mobile phone was Independent Variable.
• Dependent Variable: Forward head Posture.
 Independent
Variable
• Mention your Independent Variable
• Reading books, and Using Mobile Phone
• Example: Hours
 Sampling
• Sampling Technique: Convenient Sampling Technique

• Sample Size= 200 (using online software raosoft with 95% CI)
 Tools
• Craniovertebral angle measurement.
• For measuring the degree of craniovertebral angle we used Coral
Draw software.
• Draw an imaginary horizontal line that goes through the C7 spinous
process, which is the back of the vertebra at the bottom of the neck.
• Draw a second imaginary line from the C7 spinous process up to the
tragus, which is the pointed part in front of the earhole.

• All Craniovertebral angles measured in sitting position.

• The normal craniovertebral angle is 49.9 degree.
Angular Dimension Tool:
 Data

Quantitative data was obtained in our study.

 Statistical Analysis

angle

15-20 degree 20-30 degree 30-35 degree

Count Count Count

age 17-19 57 41 38

20-22 9 37 88

23-25 27 12 68
 angle

15-20 degree 20-30 degree 30-35 degree

Count Count Count

gender Male 71 60 53

female 22 30 141
 Semester
Frequency Percent

1st Semester 41 10.9

2nd Semester 32 8.5

3rd Semester 55 14.6

4th Semester 42 11.1

5th Semester 31 8.2

6th Semester 31 8.2

7th Semester 28 7.4

8th Semester 32 8.5

9th Semester 45 11.9

10th Semester 40 10.6

Total 377 100

Forward Head Posture * Reading Books

Angle

15-20 degree 20-30 degree 30-35 degree

Count Count Count

Book readers 1-2 hours/day 32 0 0

3-4 hours/day 21 32 8

5-6 hours/day 0 0 53
Forward Head Posture * Using Mobile
Phone
angle

15-20 degree 20-30 degree 30-35 degree

Count Count Count

Mobile user 1-2 hours/day 40 58 35

3-4 hours/day 0 0 40

5-6 hours/day 0 0 58
T-test

Book reader Mobile user t-test

Mean Mean Value

Angle Total mean 16 25 T=-0.91
 Discussion
• Our study found out the comparison of forward head postures in both
Mobile phone users and book readers. And it is statistically significant. Thus
our research question has been answered.

• Previous studies also showed the prevalence of the forward head posture
with the independent variables. But they did not shed any light on the
duration of the usage of smart phones or book reading.
• In comparison to the literature of other studies our study showed that all the
participants whether they were book readers or mobile phone users had
FPH.
 Conclusion

The results showed that:

•All the book readers and mobile users (participants) have equally
forward head posture.
There is no significant difference in mobile users and book readers.
 References
• Ayub E, Glasheen-Wray M, Kraus SJJoO, Therapy SP. Head posture: a case study of the effects on the
rest position of the mandible. 1984;5(4):179-83.
• Kang J-H, Park R-Y, Lee S-J, Kim J-Y, Yoon S-R, Jung K-IJAorm. The effect of the forward head posture on
postural balance in long time computer based worker. 2012;36(1):98.
• Page PJIjospt. Shoulder muscle imbalance and subacromial impingement syndrome in overhead
athletes. 2011;6(1):51.
• Sjaastad O, Fredriksen T, Pfaffenrath VJHTJoH, Pain F. Cervicogenic headache: diagnostic criteria.
1998;38(6):442-5.
• Ayub E, Glasheen-Wray M, Kraus SJJoO, Therapy SP. Head posture: a case study of the effects on the
rest position of the mandible. 1984;5(4):179-83.
• Kang J-H, Park R-Y, Lee S-J, Kim J-Y, Yoon S-R, Jung K-IJAorm. The effect of the forward head posture on
postural balance in long time computer based worker. 2012;36(1):98.
• Page PJIjospt. Shoulder muscle imbalance and subacromial impingement syndrome in overhead
athletes. 2011;6(1):51.
• Sjaastad O, Fredriksen T, Pfaffenrath VJHTJoH, Pain F. Cervicogenic headache: diagnostic criteria.
1998;38(6):442-5.
 Copy of the Tool Used
Name _____________________________

Age 17-19 years of age

20-22 years of age

23-25 years of age

Gender Male_________. Female_________

Weight ____________meter

Height ____________kg

Body Mass Index (BMI) ____________BMI

Semester ____________

Reading Books Yes___________. No__________

If yes: 1-2 hours/Day

3-4 hours/Day

5-6 hours/Day

Using Mobile Phone Yes___________. No__________

If yes: 1-2 hours/Day

3-4 hours/Day