Craniovertebral angle and neck disability among university students with forward head posture: a comparative study of scapular retraction exercises versus McKenzie method.

Forward head posture (FHP), commonly described as "text neck," is an increasingly prevalent postural deviation linked to extended digital device use. It leads to muscular imbalance, cervical discomfort, and impaired daily function. Corrective exercise interventions, such as scapular retraction and McKenzie techniques, are widely utilized to address FHP, yet comparative evidence of their relative effectiveness remains limited. This study aimed to compare the effectiveness of scapular retraction exercises versus the McKenzie method in improving craniovertebral angle (CVA), reducing neck pain, and minimizing neck disability among university students exhibiting forward head posture. A quasi-experimental comparative design with pre- and post-intervention assessments was employed. The research was conducted at the Faculty of Nursing, Mansoura National University. A total of 116 university students with FHP were randomly allocated into two equal groups (n = 58 each). Group A performed scapular retraction exercises, while Group B practiced McKenzie method exercises. Both interventions were administered for 20 min, three times weekly over 8 weeks. Data were collected using four tools: (1) a structured interview sheet, (2) craniovertebral angle measurement via goniometer, (3) Neck Disability Index (NDI), and (4) Numeric Pain Scale (NPS). Both groups exhibited statistically significant improvements post-intervention in CVA, neck pain, and NDI scores (p < 0.05). The effect sizes were large in both groups (Cohen's d = 0.79-1.69). However, intergroup comparison revealed no significant differences in post-intervention outcomes (p > 0.05), indicating comparable efficacy of both exercise approaches in enhancing posture and reducing neck-related disability. Both scapular retraction and McKenzie method exercises effectively improved craniovertebral alignment, alleviated pain, and decreased neck disability among students with forward head posture. Neither technique showed superior outcomes over the other.Trial registration: The study registered at Clinicaltrials.gov (identifier (NCT07317999) on December, 19 2025.