Effect of Forward Head Posture on Knee Joint Proprioception

February 23, 2026 updated by: Mariam Elsayed Elsayed Abdelkader Salah, Cairo University

Effect of Forward Head Posture on Knee Joint Proprioception and Postural Balance in Adults

The aim of the study is to investigate the effect of forward head posture on knee joint proprioception and to investigate the effect of forward head posture on balance.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Forward head posture (FHP) represents a prevalent sagittal plane deviation characterized by the anterior displacement of the head relative to the shoulder. While its impact on cervical proprioception and upper-body neuromuscular control is well-documented, current literature reveals significant gaps regarding its influence on distal joint function. This study aims to investigate the musculoskeletal system as a holistic kinetic chain, wherein cervical misalignment may necessitate compensatory adaptations throughout the body to maintain the center of gravity. Research indicates that FHP is frequently associated with an anterior pelvic tilt and altered ankle joint position errors, suggesting that postural deviations in the neck can diminish neuromuscular performance in the lower extremities. Given this interconnected nature, it is hypothesized that FHP similarly affects knee joint proprioception and stability. By evaluating these distal effects, this investigation seeks to clarify whether cervical postural deviations contribute to balance impairments or knee instability. The findings may have significant implications for clinical practice, potentially shifting rehabilitation paradigms to include cervical assessment and correction when treating patients with lower-limb injuries or chronic knee instability.

Study Type

Observational

Enrollment (Actual)

70

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • Egypt
      • Giza, Egypt, 12512
        • Mariam elsayed elsayed salah

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

  • Adult

Accepts Healthy Volunteers

N/A

Sampling Method

Probability Sample

Study Population

A head position that is overly anterior in relation to the shoulder is common in people with FHP. This postural deviation is linked to neck pain, vestibular deficits, impaired proprioception, aberrant muscle activation, and changed breathing patterns

Description

Inclusion Criteria:

  1. Ages range from 18-35years old
  2. Participants are categorized as having FHP, the craniovertebral angle (CVA) measurement is used, FHP was classified as having a CVA < 53°; thus, participants were in the FHP group when CVA was <53°. Conversely, the control group was defined as having normal or no FHP when a participant's CVA was >53°.

Exclusion Criteria:

  • Subjects will be excluded if they have:

    1. Fractures
    2. Neck pain
    3. Deformity of the spine or extremities
    4. A history of significant knee injury requiring medical treatment in the past 12 months
    5. Any inflammatory joint disease
    6. Primary Musculo-skeletal surgical interventions

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort
Intervention / Treatment
Forward Head Posture
The study used a three-part objective assessment protocol to evaluate the relationship between cervical posture and distal physical function. Knee Joint Position Sense (JPS) is evaluated using an isokinetic dynamometer (Biodex) through an active joint reproduction test. Participants, seated with 80° trunk inclination, are asked to actively reproduce a 30° knee extension target from a 90° flexion starting position while blindfolded. Third, dynamic and static balance are assessed using the Biodex Balance System (BBS) on a movable circular platform. Participants perform bilateral stance tests across stability levels 12 through 2, maintaining their center of gravity relative to a visual target. The system records the Overall Stability Index (OSI) by sampling mediolateral and anteroposterior tilt degrees. All measurements are performed in triplicate, with standardized rest intervals and familiarization trials to ensure data reliability and prevent muscle fatigue.
Device: Isokinetic Dynamometer
Isokinetic dynamometry is considered a valid and reliable method for assessing knee proprioception, particularly joint position sense (JPS).
Other Names:
  • Biodex Balance
Normal Head Posture
Measured the same as Forward Head Posture Group
Device: Isokinetic Dynamometer
Isokinetic dynamometry is considered a valid and reliable method for assessing knee proprioception, particularly joint position sense (JPS).
Other Names:
  • Biodex Balance

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Knee Proprioception
Time Frame: once
Proprioception evaluation will be started by using the isokinetic system in measurement of JPS by active joint reproduction test.
once
Postural Balance
Time Frame: once
The Biodex Balance System (BBS) is a widely recognized and reliable tool for assessing postural stability and balance control in both clinical and research settings.
once

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Craniovertebral Angle (CVA)
Time Frame: once
the angle of intersection between a horizontal line and a line bisecting the tragus of the ear and the C7 spinous process.
once

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Cairo University

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

November 2, 2025

Primary Completion (Actual)

February 2, 2026

Study Completion (Actual)

February 15, 2026

Study Registration Dates

First Submitted

February 23, 2026

First Submitted That Met QC Criteria

February 23, 2026

First Posted (Actual)

February 27, 2026

Study Record Updates

Last Update Posted (Actual)

February 27, 2026

Last Update Submitted That Met QC Criteria

February 23, 2026

Last Verified

February 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • P.T.REC/012/006195

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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