Factors associated with neck pain in university students: a cross-sectional analysis of Behavioral, neuromuscular, postural, and sensorimotor variables

Introduction Neck pain is a prevalent musculoskeletal complaint among university students, influenced by multiple interacting factors, including prolonged device use, physical inactivity, and postural, neuromuscular, and sensorimotor alterations. However, few studies have simultaneously examined these domains within a single analytical framework.Objective This study aimed to determine the behavioral, neuromuscular, postural, and sensorimotor factors independently associated with neck pain in this population using hierarchical multivariable logistic regression.Methods In this cross-sectional study, 345 university students (mean age 20.2 ± 1.9 years; 79.1% female) were recruited. Assessments included the Smartphone Addiction Scale – Short Version (SAS-SV), the International Physical Activity Questionnaire (IPAQ), the deep neck flexor endurance test, the craniocervical flexion test (CCFT), head – neck posture (PostureScreen®), and implicit motor imagery performance assessed via left/right judgment tasks (inverse efficiency score). Neck pain status was determined by self-report at the time of assessment, and pain intensity was characterized using a Numeric Rating Scale (NRS, 0–10).Results Neck pain was reported by 28.4% of participants. Hierarchical multivariable logistic regression identified sex (lower odds in males than females: OR = 0.29, 95% CI: 0.13–0.63, p = .002), higher problematic smartphone use scores (OR = 1.03, 95% CI: 1.00–1.05, p = .018), and greater deep neck flexor endurance (OR = 1.03, 95% CI: 1.00–1.07, p = .029) as factors independently associated with neck pain. The final model demonstrated modest explanatory and discriminative performance (Nagelkerke R2 = 0.095; AUC = 0.649).Conclusion Among university students, neck pain was associated with behavioral factors (smartphone addiction) and neuromuscular performance (deep neck flexor endurance).The association with greater neck flexor endurance was unexpected; given its absence in bivariate analysis, it likely reflects a suppression effect that requires confirmation. These preliminary cross-sectional associations should be confirmed through prospective longitudinal research.